HomeMy WebLinkAboutMiscellaneous - 15 MARK ROAD 4/30/2018 15 MARK ROAD
210/098.A-0023-0000.0
ND vER"i
'TOWN OARD Or HEALTH
BOARD 017 HEALTH '
146 MAIN STREET 1998
,TELEPHONE# (508) 688-940
APPLIC:?TION FOR ABA ND0A-. fE1;VT
OF SUBSURFACE DISPOSAL SYSTE:V
!SEPTIC SYSTEV)
Pursumit to Section 310 CMR 15.354
of the State Environmental Code, Title V
Name Phone
Address MAfzt4- i 047
Contractor (tired for work:
Name- 12A K► G /AeT> Phone
Address
i3o
Date for scheduled abandonment "l- 24_
The septic system at the above address has been abandoned according to
Title V specifications.
Signature' oeC tractor
Method of septic tank abandonment (check one). ( ) removal ( } sandfill
(. crush ( ) other
Name of Offal Hauler am "-W
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
Alan K Venus & Company, Inc.Property & Casualty Adjusters
Established 1982 flpo
(60)883-1882 883.1882 (617)426.3036
Fax(60)595-7728 Fax(617)426.3039
New rlampshire Massachusetts
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 of North Andover - City of North ANdover
Andover, MA 01845 Andover, MA 01845
INSURED,, Joseph Querci, Jr. &-Rose M Querci
PROPERTY ADDRESS: 15 Mark Rd.
No. Andover, MA
POLICY NO. HP0252733
LOSS OF: 11/11/92
FILE OR CLAIM NO.
,— :r is has V-ten made involving loss, damage or destruction of the above captioned
��.tir.': tray either exceed $1,000.00 or cause MASS. GEN. LAWS, CHAPTER 143,
"F1-10F 6 to be :applicable. f any notice under MASS. GEN. LAWS, CHAPTER 139,
S'7CTION 3B is appropriate please direct it to the attention of the writer and
reference to the captioned insured, location, policy number, date of
:1.0 " 'and. clair, or f ile number.
W-ie r
Title
Or! this date, I caused copies of this notice to be sent to the persons named above
1-r..;? -ad-dresses indicated above by first class mail.
11/18/92
S-ignature and Date
Suite 610
:'.?. Bax 458 31 Milk Street
Wind a:n, Neje Pampshire 03087 - Boston, Massachusetts 02109
Commonwealth of Massachusetts
TOWN OF NORTH ANDOVER/
Massachusetts �BOARD—O—F�-HEALTH
I
5 1996
System Pumping Record v----
System Owner System Location
A�
t ( �^ O. 1,
Date of Pumping: -7 Quantity Pumped: _gallons
sspool: NoYes ❑ Sec_Tank: No ❑ Yes
System Pumped by: 6444" 4i91!ey� License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
r k j j L 1 j 4 )A j A A-. 1 / 1..1 1 f
Cununonr�eallh or massachuseOWN OF NORTH ANDOVER/
i
Massachu et SBOARD OF HEALTH
DEG 2 7 1995
dee
�stci�i U��i�cr ys em Location
iIvo . /4-n-d ,
(Z— 5' 5� Quentlt,l ,'untpe�: l 060
Date of Punwiiw I
1'es u Sentir Tonl•' ^�,• Yes
Cesspool: N i_
JG
Rd
System Pumped b%'.' --r
License
Contents transferrer) to: �I LM
Date Inspector
t
