Loading...
HomeMy WebLinkAboutMiscellaneous - 21 BONNY LANE 4/30/2018N O IIN Q O O W O O O O O LC CD M rt CD O TI �► v C�rt O AO' v O A C LC CD M rt CD O TI �► 0% BOARD OF HEALTH 146 MAIN STREET TELEPHONE# (508) 688-9540 APPLICA TION FOR ABANDOAMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section. 310 CMR 15.354 of the State Environmental Code, Title V Name_ Address Contractor (tired for work: Phone Name Phone Address Date for scheduled abandonment 9Z The septic system at the above address has been abandoned according to Title V specifications. Signature of Contractor Method of septic tank abandonment (check one). (} removal () sandfill (A crush ( ) other Name of Offal Hauler 8,2 A&4 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 -,* � - c '-j Lee -4 Date D ZZ CL 30 rrz )..A Srm evn ?A9 0mc) �zm O>O �O c my 0mc s � n o —mm � m 0 e �E n = e_n z cmc, o m C n� ON O = V mm cni � o � c O �z m i m= 3E w ? S0 m� o k N rn V L-4 v U4 Lq V C. S o �Lp d >0 ° CD �3f n- > z _� r A o T CA CCC, > CO V m m S m z d x Z ID � _ C7 �m 79 T 4 Oo . T 4 X N j Z OTi A - I a r i ° m z m 0013°.�> m 00 °> \ z > A0 D z A o k N rn V L-4 v U4 Lq V /4,:� I?g 4w. -N0- 1155 APPLICATION FOR SEWER SERVICE CONNECTION r h Andover Mass. _SL North 19�j 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 o Public Works. The premises are known as No. 2- ( D�`�"— or subdivision lot no. Owner 4 �-J. Contractor 2- C A) LJJ-� Address Address App ;cant's Signature PERMIT TO CONNECT WI.T,H SEWER MAIN % ` The Division of Public Works hereby grants permission to to make a connection with the sewer main at 2 l subject to the rules and regulations of the Division of Public Works.. By Inspected by Date See back for rules and regulations c jl) Street Division of Public Works 4 .r.r,.: l t\ DATE DESCRIPTION AMOUNT 10/6/93 Pumped Septic Tank $155.00 n Bateson Enterprises, Inc. - Andover, MA 01810 Z SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED .l) I IS I PROPERLY FUNCTIONING? oe, N WEATHER CONDITIONS COMMENTS: DYE TEST PERFORMED? Y N DATE? SKETCH: c c WATERSHED 1. Name Att 14 ON y RESIDENTS QUESTIONNAIRE vv--r_�t� 1�-t TYC7 h I 2. Street Address 2 ry Y% 'Lt. O" 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool CY 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 C� 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 L7, 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. 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 theb and u type (liquid or powder) of detergent you use for: dishwasher clotheswasher S 12. Does your property have a lawn? If yes, approximately what size? less than 1/4 acre ❑ 1/4 acre ❑ more than 1 acre (Specify) COY yes ❑ no ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre acres 13. How often do you fertilize your lawn? No. of applications per year Z' Season(s) of the year 9 IP M — 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: 6 -eA s -e a -s, ❑ Check here if your lawn is maintained by a professional landscape contractor. Town of North Andover. NA Date: ?-q-9L Homeowner: Street ` oyy 1-V� Phone : — y Nature of Service: observations: Description of Work: Comments: Servicing Report Routine x Emergency .•o Num N le GF H Jud 1 5 ,gg6 Pumper Address: ( I -\ Uq _r Phone Lf7-S U I 'r! Good Condition Full to Coven Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots other (Explain) X Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner Q -: c -© V%,,, System Location Date of Pumping: 7-9-q(o Quantity Pumped: P-allons Cpl: No Yes ❑ $antic: No ❑ Yes System Pumped by: Vaad" 501!v� License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: 4 Wat:r3rshed Septic Sl►stem servicing Report Date:. -Q(p Homeo,ane r : _ �� �?�v�� Pumper Stree - :_01 Address : Phone Phone Nature of Service: Observations: : Description of Work: Comments: Routine Emergency Good Condition ec2- Full to Cover. Bafflas in Place Leacnfield Runback Excessive Solids 6�)o Heavy Grease f4a Roots too Other (Explain) -10 10�� Y 1 MY i rl