HomeMy WebLinkAboutMiscellaneous - 25 FERNCROFT CIRCLE 4/30/2018ip
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N0- 1120
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. �C4 2 _ 19
Application by the undersigned is hereby made to connect with the town sewer main in f ��%l'✓Cl�� t Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. 7--5-r- fd� r Street
or subdivision lot no.
Cb.gx-/e5 rZlc 5i2w,
Owner
Contractor
OA �, l62 4170AI
JS - c � .� C 12 c 7- C IL C le
Address
Address
C
Ap licant's Signature
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
By
See back for rules and regulations
Street
Division of Public Works
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
Ext23
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.
Name12a�eS �ijC��I61 sf r -'L
Address dS-e2NC�cSri (f /e
Contractor hired for work:
Name'Y /V/,e I 6)i�s��✓
Phone
Phone
Address 13u i' P 'e 76 " ST Al" �% c�✓o ✓ �.e �
Date for scheduled abandonmen
Method of septic tank abandonment
( ) removal
Other
( ) sandf ill
(check one).
/(crush
( ) other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspecting Agent
Comments
Date
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only 18001392-6108, FAX (800)851-8424
2/28/2010
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.36
NORTH ANDOVER HEALTH DEPT. NORTH NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 4 2010
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Re: Insured: CHARLES W AND CAROL A MCALLISTER
Property Address: 25 FERNCROFT CIRCLE, NORTH ANDOVER, MA 01845
Policy Number: 0993510
Type Loss: Windstorm due to: Other Causes
Date of Loss: 02/25/2010
Claim Number: 271507
Claim has been made involving loss, damage or destruction of the above captioned propert, which may either
exceed $1000,00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any
notice under Massachusetts General Laws, Chapter 139, Section 36 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.
MPIUA Claims Division
CMA00021