HomeMy WebLinkAboutMiscellaneous - 202 MARBLERIDGE ROAD 4/30/2018:s?
BOARD Oto HEALTH
146 1MAIN STREET
TELEPHONE# (508) 688-9540
AI'PLICA TION FOR .4B.AA,-D0:"�:1,IENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
Name_jZj-" P1 2 v
Address ��7
Contractor ]tired for work:
Name rp V� i 1.
Address 7o,--
Phone
ESDh
Phone 47'> - I Z -3 7
Date for scheduled abandonment /0 1 (�
I
The septic system at the above address has been abandoned according to
Title V specifications. �—
Siananu-e of Contractor
Method of septic tank abandonment (check one). O removal O sandfill
( V\ crush ( ) other
Name of Offal Hauler &L 64
This form must be returned to the North Andover Board of Health
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEAT TH
REPRESENTATIVE'S USE ONLY.
l t& /96
Inspecting Agent Date
t.
` ' '' ' -
1-64 2&
SEPTIC SYSTEM INSPECTION FORM
ADDRESS -Z 6'Z b'vi b ��
DATE INSPECTED SD y
PROPERLY FUNCTIONING? Y N
WEATHER CONDITIONS
COMMENTS:
WA i Ep, 4Z:ALi i i TEST -N'?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
° r LF doss b U
��9 elf b lo' s �y -
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
0
2. Street Address c969
3. How many members are in your household? C%WC�
4. What type of sewage disposal system do you have?
esspool
septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Area plans (drawings) for your sewage disposal system on file with the Board of Health?
�
yes ❑ no ❑ do not know
6. Ho old is your sewage disposal system? El 0-5 years El 6-10 years El 11-20 years
Ho
20 years ❑ do not know
7. Has your se wa disposal system been rebuilt or repaired?
❑ yes Ino ❑ do not know
If yes, approximately how long ago? years. What was done?
- 8. How frequently is your sewage disposal system pumped out? Lit' 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 L7 no _...
If yes, what problems.
❑ repeated pump -outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
1.00. How many of each appliance are connected to your seage disposal system?
washing machine rr✓✓ 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"<<°�$�`����"' PAu,bR
clotheswasher 'ALL -- PC L&46,R
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 law
No. of applications per year
Season(s) of the year S/oif/N CF4
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.
Town of North Andover, MA
Watershed Septic System
Servicing Report
7
Date: Id
Homeowner: Pumper DANIEL A. GIARD
SEP I IG SERVICE
Street : 0Address: Rin ANDD ER gee
Phone (� ji `7 �� / Phone (508) 686-7653
Nature of Serd Routine
Emergency
Observations: Good Condition f
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Description of Work:
Comments:
l