HomeMy WebLinkAboutMiscellaneous - 164 JOHNSON STREET 4/30/2018 164 JOHNSON STREET
210/097.0-0006-0.0.00.0
July 22,E 1955
--J� ; J'
Ur, Irving C. Howes
164 Johnson Stroot
Porth Andovery ;iassachusetts
Doer Zr. Howes;
The Department of Public Health has recontly completed a
sanitary survey of the rratorshed of Lake Cochicherickp
the source of water supply for the term of North Andover.
This report states that there exists on your pr^misoa fAn
overflowing septle tank, a violation of Rule W of the
Rules and Regulations; adopted by the State Department of
Public Health In 1312 for the purpose of provontiaG the
pollution of the eaters of Lake Cochichowick. A copy of
the rules is enclosed.
You are hereby notified to correct this violation,
Should you care to discuss the matter further or obtain
any additional information heretofore, please consult the
forth Andover Board of Health.
Yours very truly,
BOARD OF HEALTH
Bye-Mr.ry F. Sheridan# Agent
WATERSHED RESIDENTS QUESTIONNAIRE
r-
1. Name c9- zNr zg. G ,-.
1 2. Street Address cCIA 7
3. How many members are in your household? v a. C + S
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 ❑ 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. 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 X 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 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
clotheswasher
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 la n?
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:
i nA& c
❑ Check here if your lawn is maintained by a professional landscape contractor.
F
S' ONN
ti
AIREC
2. Street Address rQla
3. How many members are in your household? Va
4. F.h ikat type of sewage disposal system do you have?
cesspool
L septic tank and leaching area
connection to municipal sewer
other (describe)
i i do not know
5. Arra 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 ears ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
i
7. Has your sewage disposal system been rebuilt or repaired? x
❑ yes ❑ no ❑ do not know
1
If yes, approximately how long ago? years. What was done?
a
S. How frequently is your sewage disposal system pumped out? ❑ annually f
❑ 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. Heir many of each appliance are connected to Baur sewage disposal system?
washing machine ✓_ dishwasher garbage .disposal
dehumidifier drain sump pump toilet ✓
roof/pavement drains shower/bathtub T
11. please state thL- brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ Less than 1/4 acre ❑ 1/4 acre ❑ 1/2acre 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 fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
Insurance Adjustment Service, Inc.
139 Billerica Road, Unit A-1
Chelmsford, MA 01824
(978) 256-3334
Fax (978) 256-3354
UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B
Date: December 23, 2008
TO: Board of Health/Building Inspector
RE: Insured: Ruth Osgood
Property Address: 164 Johnson St RECL.
4
No Andover MA 01845
JAN 0 5 2003
Date of Loss: 12/12/2008 TOWN OF,N,
HEALTH,
Policy Number: HMA2051326
Type of Loss:
Yp ice covered trees fell, causing wire to pull away from dwelling.
File or Claim Number: 52268
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. 38 is appropriate,please direct it to the attention of the
writer and include a reference to the captioned insured, locations, policy number, date of loss and claim or file
number.
Thank you for your cooperation.
Very Truly yours,
Tim Martino
Adjuster
Ext. 135