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Home My WebLink AboutMiscellaneous - 19 FERNCROFT CIRCLE 4/30/2018 19 FERNCROFT CIRCLE le 210/1113.0-D 102-0000.0 7 2. S:reet Address 3. How many members are in your household? `-� 4. What type of sewage disposal system do you have? cesspool septic tank and leaching area L r 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? F4/ yes ❑ no ❑ do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ,�l 11-20 years over 20 years ❑ do not know i. Has your sewage disposal system been rebuilt or repaired? L_ yes 9- 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 yea ❑ never 9. k%^v e you had any problems with your sewage disposal system? ❑ yes no a` yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground v'• many of each appliance are connected to your sewage disposal system? marching machine dishwasher garbage disposal dehumidifier drain sump pump toilet T-oif/pavement drains shower/bathtub 11. Tease state the brand and type (liquid or powder) of detergent you use for: d=.E:hwasher C�/� L- _IC"heswasher �1 L 14. Does your property have a lawn? II yes ❑ no :f yes, approximately what size? less than '/4 acre ❑ '/4 acre ❑ '/2 acre 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. often do you fertilize your lawn? : 101. Of applications per year pec :?n(s) of the year 14. V3,se state the brand and type (liquid or granular) of lawn fertilizer you use: r,ijcek here if your lawn is maintained by a professional landscape contractor. NEW ENGLAND CLAIMS SERVICE, INC. Incorporated 1985 0 Reply To Reply To Mansfield, MA 02048 a;. W�_ 131 Dodge Street,Suite 6 P.O. Box 345 fi �� Beverly, MA 01915 ISSWA FNT TEL. {508}337-8058 � =k` TEL. {978}927-3000 FAX{508}339-5835 f FAX{978}927-3002 wrandall@newenglandclaims.com Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec 3B To: Building Commissioner or Inspector of Buildings _ City Hall - North Andover, MA 01845 RE: Insured: Flynn, Camille &Gerald B. APR 0 3 X014 TOWn OF NCR 7ri ANDOVER Property Address: 19 Ferncroft Circle � EALTt-1 DEPART;,;ENT Cause of Loss/Date: Water 2/11/2014 File or Claim No: BOS052074 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SEC TiOiv 3B 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. Section 3B. No insurer shall pay any claims(1) covering the loss, damage, or destruction to a building or other structure, amounting to one thousand dollars or more, or(2) covering any loss, damage or destruction of any amount,which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code,to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending;provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or toNbm under the provisifli:s of this section, oI for amounts not disbursed to a city or town under the provisions of this section. Paul A. Dionne General Adjuster 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 Date Y S ..oar,,.. 'af` •. o '�`HO BOARD OF HEALTH 120 M/ � S 1��ET TEL. c82 X83 '�r;�N sE "7 NORTH Al�IDOVER, MASS. 01843 E:« 3 �J APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) PURSUANT TO SECTION 310 CIR 15 . 354 OF THE STATE ENVIRONMENTAL CODE, TITLE V This form must be submitted to the Board of Health no less than five ( 5) dans prior to date of abandonment and be accompanied with a coon of the sewer connection oe Lit. Name Phone Address /4 !' --rV-1 C, e Contractor hired for work: Phone Name elcar-�c� f Address Date for scheduled abandonment Method of septic tank abandonment (check one) . ( ) removal ( ) sandfill ( ) crush ( ) other (describe belcw) Other PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT ' S USE ONLY Inspecting Agent Date Comments ,r N23 1139 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. �� _ 19 Application by the undersigned is hereby made to connect with the town sewer main in_ / Street, subject to the rules and regulations of the Division of Public rks. ZZThe premises are known as No. Street or subdivision lot no. Owner Address Contractor Address \ �1 l) Applicant Signature Z A16 PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations SEWER SERVICE INC. COMPLETE SEWER-SEPTIC DATE OF SERVICE INVOICE SERVICE A0 s�s� CUSTOMER N E BILLING A DRESS (508) 683-5709 (508) 470-1400 Methuen, MA Andover, MA CITY STATE ZIP PHONE: (508) 937-9889 (508) 851-8839 ��G�,��-- Dracut, MA Tewksbury, MA JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS (603) em, NH 39 ( Bill rica, M 33 Salem, NH Billerica, MA ADDRESS STATE ZIP DESCRIPTION OF WORK VACUUM PUMP EPTIC TANK GALS./ ❑ CESSPOOL ❑ OVERALL SYSTEM ❑ DRYWELL ❑ BASEMENT ❑ FAILED SYSTEM DRAIN LINES CLEANED ❑ MAIN LINE: FT. ❑ BATHTUB: FT. ❑ KITCHEN SINK: FT. ❑ TOILET BOWL: FT. ❑ FLOOR DRAIN: FT.I❑ VANITY: FT. ❑ OTHER LINE: FT. WORK ORDER AUTHORIZATION USE ONLY ON CHARGES GUARANTEES INVOICE AMOUNTS I hereby authorize you to perform the above described services and PARTS $ 1 agree to pay the amounts indicated to the right. I hereby certify that I am duly authorized to order and approve the work requested. Interest @ 1.5 per month 18% per annum on past due balances. LABOR SIGNATURE TITLE OTHER OTHER TERMS OF PAYMENT TYPE OF SERVICE TAX EXEMPT CASH G RES/COMM ❑ # TAX INDUSTRIAL ❑ CHECK ❑ CHARGE E PLUMBING 1,1TOTAL $ J / JOB COMPLETION This is to acknowledge completion of the above describ work which has-been docrce to my o plete satisfaction. 3 DATE CUSTOMER SIGNATURE E ICEMAN'S NAME SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED ` PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS : WATER QUALITY TES f E:b 7 JZESw-TS? DYE TEST PERFORMED? Y N DATE? SKETCH: s.. i /- Ydessl'6k&C-16-6F c-c R Title of File -� Page of Date File Open: Date file closed: Doc Document/Action Title Date of. Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department � G. Insurance Adjustment Service, Inc. 435 King St. Littleton, MA 01460 (978) 952-6966 Fax (978) 952-2459 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B Date: February 8, 2005 TO: Board of Health/Building Inspector N Andover, MA 01845 rFEB 1 1 200ECEIVED RE: Insured: Rose Struffolino TOWN OF NC- Property Address: 19 Ferncroft Circle HEALTH{ ��-arw--xy _ North Andover, MA 01845 Date of Loss: 1/26/2005 Policy Number: HP 1562747 Type of Loss: Ice Dam File or Claim Number: 20382 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. ly urs, Mike at Adju er Ext. 1 1 J