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SEPTIC SYSTEM INSPECTION FORM
ADDRESS 2 -[ oo
DATE INSPECTED
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS:
WATIER QL'ADTy fi ES i Fid 2 ReesOi- T S-?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
0
WATERSHED RESIDEN�TS QUESTIONNAIRE
1. Name
2. Street Address
3. How many members are in your household?
4. What What type of sewage disposal system do you have?
❑ cesspool
Pr septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are he 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` -P -
❑ over 20 years ❑ do not know
7. Has your sewa disposal system been rebuilt or repaired?
El yes Vno ❑ do not know
If yes, approximately how long ago? — years. What was done?
8. ;every
y frequently is your sewage disposal system pumped out? El annually
�j
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. How many of each appliance are connected to yourewage 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 0-xJ1 iFf,,'Y p o w de V-
clotheswasher A�-4 A r11 ui d Po
12. Does your property have a lawn? Ltd' yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre 1 �-❑ 1/i acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lam?
No. of applications per year �
Season(s) of the year AS:
O
14. Please state the brand and type (liquid or granular) of lawn fertilizer you
use:
G /7 B /.� 1�. - ,/ d, - �-a ,� !3� �-G iJ 1. �/I r 6- h Ck' l a V-
9--tI—
heck here if your lawn is maintained by a professional landscape contractor.
Name
Addre
BOARD OF HEALTH
1=16 NIAIN STREET
TELEPHONE# (508) 688-9510
APPIICA TION FOR ABANDO;�'�1LVT
OF SUBSURFACE DISPOSAL SYSTEV
!SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
Contractor (tired for work:
Name_
Address
c�)`o� � Phone
�3� Ce
Date for scheduled abandonment 10-1-1-90
The septic system at the above address has been abandoned according to
Title V specifications.
S�Panire ofL ontractor
Method of septic tank abandorunent (check one). O removal (} sandfill
(crush ( ) other
Name of Offal Hauler
r �
This form must be returned to the North Andover Board ofHealth.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
)� I of
Inspecting Agent
`t
Date
? clz� Iv;
,djl
i-
N2 2073
Date.................................. �—'
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�1-►,., t4�
This certifies that ..................... ............... ... ........................ t
has permission to perform .......... ... f-....................... ......
... "-�
wiring in the building of - ✓LG'�^~."
North Andover, Mass.
�.:....... Lic. No`7P ?i..........................................................
ELECTRICAL INSPECTOR
10/09/98 10:49 2'5,00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
-�-� Office Use Only
041 T11M 111nWPr# Df 4Jca55arh1I�Pf5 Permit No. 7�
-�
!�. t�1tIPtIfPtii of Pt21t1iL �IIf£Ij) � Occupancy ,& Fee Checked.
k" 0 QW11 HOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 Peeve blank)
APPLICATION, FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMA 12:00
(PLEASE PRINT IN INK OF TYPE ALL 114,FORMATION) Date /0Z( --9F
City or Town of 04 -LA P11e e To the .Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) Xi`( VJ Oo d 'lie r -s b/2 �(re,
Owner or Tenant
Owner's Address
S A'tn-t e-
❑
Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box)
Purpose of Building /? C$ / CliteAAc -eUtility Authorization No. &-d ?3TI
Existing Service Amps `dolts Overhead ❑ Undgrnd ❑ No. of Meters
New Service Amps 1, Volts Overhead ❑ Undgrnd ❑ No. of Meters_
Number of Feeders and Ampacity _/ -1
Location and Nature of Proposed Eiectrical Work u N L' d e i%2 CLL-, � 7,t re \1' G e /C r—P,4 0 e
No. of L &:ting Outlets _P I No. of Hot Tubs I No. of Transformers 7KVA
No. of Lignting Fixtures I Swimming Pool Above_ In- r—
grnd. ' gm
d. J Generators KVA
No. c Emergency Lighting
No. of Recectacle Outlets I No. of C,: 3urners Banery Units
Nc. of Switch Outlets
I No. of Gas Burners
FiR_ ALARMS No. of =ones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Comz;,ned
Detection/Sounding Devices
Local C I ConnecnMon esti Other
or,
No. of Ranges
' No. of Air Cond. Total
tons
No. of Diecosais
I No.of Heat Total Total
Pumps Tons KYV
No. of D!snwashers
I Space/Area Heating KW
No. of Dryers I Heating Devices KW
No. of Water Heaters KW
No. of No. of
I Signs Ballasts
Low Voltage
Wiring
No. Hydro Masszce Tubs
No. of Motors Total HP
OTHER:
`,%INSURANC_ COVERAGE: Pursuant to the require^ents of Massachusetts general Laws
I have a current :lability Insurance Policy includir, 7,omol etWOperations Coverage or its substantial equivalent. YES V-_-NOO 1
ffi
"ve submitted valid proof of same to the Oc e. YE- NO C If you have checked YES, please indicate the type of coverage by
checking the apprc� fite box.
INSURANCE ®' BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S \ . !�
Work to Start inspection Date Requested: Rough Final l� NI
)A
under the Penalties of perjury , QQ
FIRM NAME haw- `� ' �Ntn�ZZl 'N LIC. NO. 13 S Z /{
Licensee W ' 0 A'01,.0, ?iZ Signature 1�/l LIC. NO.
(1 �� (� /'YJ dG1f Bus. T o. `?9 e— 416 -7300
Address 2 7 C L 0,4.1 -e S " � ' d� 1 M �' Att. Te:. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does ne! have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent
(Please Check one)
Telephone No. PERMIT FEE S
(Signature of Owner or Agent) x6565