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HomeMy WebLinkAboutMiscellaneous - 143 SANDRA LANE 4/30/2018 J143 SANDRA LANE 210/097.0-0069-0000.0 BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM, MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE (978)741-5731 FAX (978)740-9109 September 13, 2001 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01945 North Andover, MA 01945 RE: Insured: Francesco & Caroline Gracaffa Address : 143 Sandra Lane North Andover, MA 01945 TO I Policy No. : H01 2 04 44 18 V Loss of: 09/10/01 File or Claim No. : 17-1798 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. David Vincent Adjuster WATERSHED RESIDENTS QUESTIONNAIRE 1. Name a W N G [s d- �4 S2 fh �Lcct '0 2. Street Address /q.1 n iq L w\1 e, 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area CK connection to municipal sewer ❑' other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no ❑ do not know'-- 6. How old is your sewage disposal system? ❑ 0-5 years N 6-10 years ❑ 11-20 years_= ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes X no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years ❑ every 5-10. years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes ® no _ If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each applian a are connected to your sewage disposal system? v washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher 14C L- clotheswasher )4L/- 12. Does your property have a lawn? ® yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre I® 1/4 acre ❑ % acre ❑ % acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: 0 Check here if your lawn is maintained by a professional landscape contractor. - BUTTERWORTH & O'TOOLE, INC. P.O. BOX 8294 SALEM,MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE (978)741-5731 FAX (978)740-9109 September 13, 2001 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01945 North Andover, MA 01945 RE: Insured: Francesco & Caroline Gracaffa- . _t__ Address : 143 Sandra Lane p � � a North Andover, MA 01945 Policy No. : H01 2 04 44 18 Loss of: 09/10/01 File or Claim No. : 17-1798 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. David Vincent Adjuster