HomeMy WebLinkAboutMiscellaneous - 148 BRIDLE PATH 4/30/2018 148 BRIDLE PATH �, \
/+ 210/104.G0075-0000.0 }
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BOARD OF HEALTH
27 CHARLES STREET .
NORTH ANDOVER, MA 01845
TELEPHONE# (978) 688-9540
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEAP
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
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Name - L A w Phone
Address t LK/
Contractor hired for work:
Name Phone ted' t -- C, 5 _z-'
Address �s VVX-A-6
Date for scheduled abandonment {l 0
The septic system at the above address has been abandoned according to
Title V specifications. 'e (�
� Signature of Contractor
Me od of septic tank abandonment (check one). Oremoval O sandfill
crush O other
Name of Offal Hauler ��-✓��5
This form must be returned to the North Andover Board of Health.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
Inspecting Agent Date
DEC 1 8
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ANDOYE�Q,
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an lover
consultants A" " fq�,
8 Tilton Street, Methu No ;az
en , Mass. ` ��c��F�.c�.���'j�
Tel. 687- 3828
•SE �-v G WiT,y ATTAR"</E
711,_ ��T��'S 7'.Q,//E 4.s -, ,�. ��2T/�'/CAT/n.y
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT• '57 T FUT � �� S Phone GBG '
LOCATION: Assessor's Map Number a Parcel
Subdivision - Lot(s) 7 5
Street � f 0 /V)/F St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
Date Approved
Septic Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
65 SALEM STREET,LAWRENCE,MA 01843•Tel.508-975-7117
MORTGAGOR rAK -S. gt7rJe—s✓ DEED REF—Z5--5?—PG. t
ADDRESS OF PRINCIPLE BUILDING PLAN REF.
lA b SIZII2 tk Po-ra DATE OF INSPECTION: VhIC. 1 I Q90 j
No�t1 Anlvo.i f✓Q. Ma. to Se,4t. •F0/
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I STATE THAT IN MY PROFESMONAL.
NOTE: This mortgage Inspection was "parol OPNXM 60 s
specifically for mortgage purposes and Is not to be relied odwiftc CONFORM
upon,as a survey, Northern Associates. Inc aooepts no %101 �
responsl4flity for damages resulting from said reliance by �� n hof
anyone other than the said mortgagee and its assigns in S t of major
connection with its proposed mortgage financing to said • korovowts Wow way am$$ except as
mortgagor. (11 N
CERTIFICATIONTO: CO. .1)112 V
PZV1=, +r-iAr.. l4ortf Na.t'1 L. PQrsltPt�t t.' y^ inor r
This mortgage inspection was prepared in accordance ({ Isa Hazard
with the Technical Standards for Mortgage Loan kg 1tlR� tssu a t Hazard. j
Inspections as adopted by the Massachusetts Association pmad m dolor la st F
of Land Surveyors and Civil Engineers.Inc.
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BAY !`,TATE Aldll,'�TNIINT
• Nlnwa raulct 1'C) BOX 3311ao
y,ana,r
Al Al,0VEIt. MASSA(:I IWJL 1 11.' 01t31u Ua Its JA
ZA-vFAx k .utfAndover: 47513111Lowu11: 458-2542 luau I
+ I lavoili l: 374 U28;' l ynlr 598-5050
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'1'01411/ FIRE DEA'ARTM1:NT I,
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BUILDING COMMISSIONER ,r 110 ) OF HEALTII or Ii
SPECTOR OF ILDINGS 11t)AItl1 OH SEL0—IREI.
_ TOWN OF NORTH ANDOVER--_) ( TOWN OF NORTH ANDOVER
TOWN HALL _ ._ .-.__) ( _ TOWN HALL
NORTH ANDOVER, MA _01.845 (_ NORTH ANDOVER, MA 01845
RE: INSURED: STEVEN �1...._. -_LINDA_-WEEKS . .
PROPERTY ADDRESS:_148 BRIDLE PATH LANE, NO. ANDOVER, MA
POLICY NO. : H 3 0 2 4 3 8 6 ('Ot•111ANY: NEW LONDON COUNTY
LOSS OF: WATER DATE; OCTOBER 14 1992
FILE OR CLAIM
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Claim has been made Involving ]uss, damage o i de;ct.rucl-ion of the above �
captioned property, which uuly u l OWI_ uxc.:cd $i ,000.00 ur cause Massachusetts
General Law, Chapter 143, Sucl.:ion ti Lo I,c .,pill i,:ill)10. if any notice under
Massachusetts General l.aw, talaL)tcr 139,-- Sect Ion_311 is appropriate, please
direct it to the atteuti,,,► of Lhe writer anal luclude a reference to a
captioned insured, locaLftoi, pulic:y numhL'l-, datL: of loss and claim or file E
number.
WALTER M.._ KORNACHUK, GENERAL ADJUSTER
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On this date, I cau.5ed cop i cti of this notice to I,,, selat to the persons named
above, at the addresses indicated al,ovc, by first class mall.
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11/12/92
SignaLure Date I