HomeMy WebLinkAboutMiscellaneous - 21 HIGH WOOD WAY 4/30/2018 (2)Patricia A bdinoor
21 Highwood W
North Andover AA -01810
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
TEL. 682-6483
Ext 23
This form must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name Phone
Address
Contractor hired for work:
Name Phone
Address
Date for scheduled abandonment
i
I
Method of septic tank abandonment (check one).
i
( ) removal ( f sandfill crush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Ins ng Agent Date
Comments
'r
° 1995
0
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
1
19
Aoolication by the undersiened is herehv made to connect with the town sewer main iniG
:oV
j
Street.
subject to the rules and regulations of the Division of Public Works. \1
The premises are known as No. Street
or subdivision lot no.
Owner
e,> /-/-?
Contractor
Address
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
By
Inspected by
Date
See back for rules and regulations
Street
Division of Public Works
NORTN
A
�9SSA C H USEtS�
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
TEL. 682-6483
EXL23
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
This form' must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a copy of.the sewer connection permit.
-
Name � �)) �"I n c�, (c, 2sc�!? Phone
Address
OContractor hired for work:
Name Phone 0
Address
Date for scheduled abandonment
Method of "septic tank andonment (check -n-e-)—.----
removal
n-e).----removal (` sandfill ( crush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE.BELOW
Date
Comments
0
N 0-
0
1110
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. _ 19 _ISS
Application by the undersigned is hereby made to connect with the town sewer main in _L� Street,
subject to the rules and regulations of the Division
of Public Works. ! �
The premises are known as No. ( i; G ✓1 C,G tr Street
or subdivision lot no:
Owner �^ Address q
Contractor Address
Applicant's Signature
O ✓
C_ G
Co Al sEfz VAT
No
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
See back for rules and regulations
Street
Division of Public Works
SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED
PROPERLY FUNCTIONING? 3 N
WEATHER CONDITIONS
COMMENTS:
WA ER aVALi'i Y 'T ES 1 F, <' ?�SUi TS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name TW�C_14 "Dz1vo0'r
2. Street Addres r
V
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 L' do not know.
❑ 11-20 years
6. How old is your sewage disposal system? ❑ 0-5 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes V no ❑ do not know
If yes, approximately how long ago?
❑ 6-10 years
years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually
[T� every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes [B'" 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 aw
roof/pavement drains shower/bathtub _V***'
11. Please state the brand and type (liquid or powder) 'of detergent you use for:
dishwasher --- ,, 5 Q d C_ _
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 LT 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.
I
TO: NORTH ANDOVER, MASS CC11,-')�-2 19�
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected, the construction of the said disposal system at
cam- -z;n �,c(:� Loi ,.
� North Andover, Mass.
S17E LOCATION
The< '
gds construction are as specified in my plans and specifications dated
G e-'7 C/ ?3&-0 Pz S /. £r F7T. Lowe
Re . Prof. Engineer/Reg. Sanitarian
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SWEENEY & SARGENT �
ATTORNEYS AT LAW
316 ESSEX STREET
LAWRENCE, MASSACHUSETTS 01840
( 817) 886-3918
CLIFFORD E. ELIAS
I R V i NG W. SARGENT (1903-1973)
OF COUNSEL
ARTHURSWEENEY
MICHAELW. MORRIS
November 24, 1975
George E. Merrill & Son, Inc.
38 School Street
Salem, New Hampshire 03079
Re: Drain, North Andover, Massachusetts
;54
Dear Sirs • ' Ul/ii✓�'
I
Please be advised that this office represents John
Abdinoor of North Andover`, Massachusetts. Mr. Abdinoor
has referred your bill to him to this office. My client
has discussed this matter with the various contractors
and town officials involved.
Because of the contradictory stories we have heard
and because various allegations of fault have been!levied,
and because my client has. done nothing wrong in any way,
we must necessarily refuse to pay this bill.
If you have any further questions regarding this
matter, I would suggest you contact Mr. Gelinas of the
Town of North Andover.
MWM:lbs
ry trul yougs',
wz "/
chael W. Morris
TO: NORTH ANDOVER, MASS
BOARD OF HEALTH
FROM: DESIGN ENGINEER
Ocn) fJ� i 2- 19 —) �_
Re: Soil Absorption Sewage
System Inspection
This is to certify that' I have inspected the construction of the said disposal system at
Lo T . North Andover, Mass.
S17E LOCATION
The construction are as specified in my plans and specifications dated
L ---lc/`/ T [_ ;-1 SES
ria
Rc . Prof. Engineer/Reg. Sanitarian
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