HomeMy WebLinkAboutMiscellaneous - 159 FRENCH FARM ROAD 4/30/2018 159 FRENCH FARM ROAD
J 210/035.0-0083-0000.0 2d.
Ad� ress 69F�, H ����� � q _ Title of File
Page of
Date File Open: Date fele closed:
Doc Document/Action Title Date of Refer to other Purpose of Documeant/Action and notes.
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department
f
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name T. 1-f. (fa it D A-No
2. Street Address IS9 FR 6 N C N F�� i`� zD
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 ❑ 6-10 years ❑ 11-20 years ,
❑ over 20 years ado 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. 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 .[�k_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 appliance are connected to your sewage disposal system?
washing machine dishwasher _I garbage disposal
dehumidifier drain sump pump toilet 3
roof/pavement drains shower/bathtub L-
13. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher -'Z-V G X y
clotheswasher 7-1 4) 4�
12. Does your property have a lawn? ❑ yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 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 Z
Season(s) of the year SP. 5-
14.
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
1 ❑ Check here if your lawn is maintained by a professional landscape contractor.
7
& CorniNpnany1,. nC
ordo� Boyd
Multiple amine Adjusters& Surveyors • Estuu-ished M6
A Subsidiary of National Claims Service, :nc.
TELEX NO. 466111
CABLE: BOYDCO
ADDRESS REPLY TO:
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch. 139, Sec. 313
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
( lawn Hco l
addresses n/`zA � _ dljP'r Aly
�D G` er SU i Xl
)
Re: Insured: b�i� i C�d ��� Ci MQ
Property address: / 9 rre r\r k
A t-1� A►'�t�c�e�n'I
Policy No.
Loss of 19 9/
File arEtaim-No. 1 ��
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. 313 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. �J
U
T' e
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
Signature and date ( I
1
MASSACHUSETTS CONNECTICUT NEW HAMPSHIRE VERMONT MAINE RHODE ISLAND
Boston Lawrence Bridgeport Gorham Burlington Augusta ProvidencefMn
Barnstable Pittsfield New London Keene Montpelier Lewiston IfaU '�I�a�
Brockton Salem No. Haven Laconia White River Jct. S. Portland NEW YORK l UNI {Ila
CLAIMSSERVICE OF Fall River Springfield Waterbury Manchester Utica
- ENGLAND,NEW NG �ND.INC. - ..._
NEW
J1Jq Fitchburg Worcester W. Hartford Portsmouth