HomeMy WebLinkAboutMiscellaneous - 140 APPLETON STREET 4/30/2018 �- _- .1
140 APPLETON STREET 2t
2101037.6-002&0000.0
1
l
Town of North .Andover, MA
Watershed Septic System
servicing Report
Date: /� 9
Homeowner: FCA*' Pumper :
Street : MAIM
/Y6 -*9! i Address: SEPTIC SERVICE
Phone : 6-F.3-39/ ?� Phone —19 T'-ANUOVER,
ER MA
wwou-
Nature of Service: Routine /
Emergency ✓
Observations: Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Description of Work:
Comments:
N°R7
BOARD OF HEALTH
n
' � ;,,_th•• 120 MAIN STREET TEL. 682-6483
SS^CHUSE� NORTH ANDOVER, MASS. 01845 Exc23
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15. 354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
This form must be submitted to the Board of Health no less than
five (5) days mrior to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name �ah t,����/�So'+J Phone
i
Address A/6 9�A j % j
Contractor hired for work:
Name iv�-e./ Cr � 2d Phone
Address /3 b oq
Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) removal ( ) sandfill crush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspectinge4e Date
Comments
N°., 1057
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. lw 19 C
Application by the undersigned is hereby made to connect with the town sewer main in 'TD�.i' ,byc J I Street,
subject to the rules and regulations of the Division of Public Works. J
The premises are known as No. /4o o AI 1 l L� Street
or subdivision lot no.
Owner / w > /� Address
lyl r I YGLK C.71Cc✓� 1
Contractor Address
ppl(cant's Signature
y
oA�D o 1fELTiN
Co uS�' ,4Ttp�
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
Date
z See back for rules and regulations
Address Lt b STTitle of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and nates
action Document/ document/
Num• Action De artment
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Buiidin Department
1;Z017
/ • � �A�����L�'/l� O\1•/lam
Please forward us as much of the following information that is possible,
1. Type of system
2 . A Qe �S L
3. Locations
41/
L}. Maintenance records and date° of last pumping; out
1
e
5. Documentation of repairs and reconstruction
6. Site conditions
7. Builder of system
8. Engineer who approved:
Site
— System
R� Installation Procedure .
1.0, Problems
f