HomeMy WebLinkAboutMiscellaneous - 274 BOSTON STREET 4/30/2018 (3)Commorwmalth of Massachusetss
, Massachusetts
System Pumoing Record
System Owner
Q
Type: Emergency Routine.
Cesspool; No /0 Yes
Date of Pumping.
System Pumped By: Wind Nver Enwhomnental, LLC
Contents transferred to:
Contents Disposed at:
Date:
System/Other Comments
Pumper Signature:
rstem Location
Ir 14—
'. t Aw . L
Form 4 -- System Pumping Record
r
Septic tank: w F --]Y-- M
Quantity Pumped: IS -Z261 Gallons
Permit #:
t
bep Approved Form - 12/07/95
PATRICK J. DONOVAN ASSOCIATES, INC.
Claims and Loss Adjustments
P.O. BOX 110
WAKEFIELD, MA 01880
Tel. (781) 245-5540 - FAX (781) 245-7016
January 24, 2003
Building Commissioner
City or Town Hall
North Andover, MA 0 1845
Insured
Property Address
Insurer
Policy Number
Type of Loss
Date of Loss
Our File #
JAN 3 1 2003
Gary & Cheryl Fenton
274 Boston Street, North Andover
Preferred Mutual Insurance Company
PHOO100544190
Sewer Pipe
01/23/03
WAP34361
Claim has been made involving loss, damage or destruction of the above -captioned
property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143,
Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section
3B 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 file number.
On this date, I caused copies of this notice to be sent to the persons named above at
the addresses indicated above by first class mail.
k6ssell Williams, Adjuster
RW/so
I
_J
