HomeMy WebLinkAboutMiscellaneous - 148 SANDRA LANE 4/30/2018 / 148 SANDRA LANE
/ 210/097.0-0086-0000.0
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name r /!q E2
2. Street Address
i
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
"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 Z b-10 years ❑ 11-20 years'
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes no ❑ do not know
If yes, approximately how long ago? years. What was done?
`. 8. Hb 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
❑ s stem clogs, backs up, or drains slowly _
dors // -Z��7/vl
Elsewage)-urfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher garbage disposal
dehumidifier drain sump pump toilet
1 roof/pavement drains shower/bathtub _LG
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher CAS r-4.0 ta
clotheswasher ->~ e�
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
El less than 1/4 acre 0 -/4 acre ❑ 1/z acre ❑ 3/4 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 fe ilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
1 ,
JAMES A. TRUDEAU
Adjustment,Service Inc.
James Trude'au
P.05 Box 208 Thomas
Murphy
Templeton;MA 01468 47 Green River Road
Phone:.978=939-2255. Greenfield,MA 01301
Fax:.978-9394234. Phone: 413-774-5.124
_. Fax: 978-939-4234
Notice of Casualty Loss of Building
Under Massachusetts General a Laws, Chapter 1
p 39,Section 3B
June. 10, 2005,.:
Building Inspector
.400 Osgood:Street .
North Andover,'.MA 01845
/hoard of Health E. 7
V 400 0sgood Street 7LW
North'Andover,.MA 01
845
2005
Fire Department
Dept. of Records
,
124,Main Street -:--
North Andover, MA 01845„
Insured: James &Maria Rosati---
Loss Location: .. �~`"
14
L 8 Sandra Lane North h Ando
Insurance Company:- Preferred Andover, MA 01845
man .
p y• Preferred M
utualI
Insurance Co.
Policy No.f P1100100532855
Date of Loss:. June 4,.2005
File Nuinberr 05-03910
Claim Number: 05008308
Type of Loss: Property Damage
Claim 1
has b
een ma
Sl.e.involvi ng loss, damage, or,destruction of the
�I exceed � 1 0 above captioned property, whichv ;
$ 00.00, or cause "Mass. Gen. Laws Chapter_143, Section 6" to be applicable. If any notice under
"Mass: Geri: Laws Chapter 139 Section 3B" is appropriate, please direct it to the writer and include a reference
to the captioned insured, location, policy number, date of loss, and file or claim number.
On this date, I cause.copies of this notice to be sent to the persons named med
� ) above at th
class mail:_ :„ _;, , e d
address indicated'by
. . Y .first ,
Sincerely.
ohn Stefanci l
laims Adjuster.:
ChptrLtr(102) :.