HomeMy WebLinkAboutMiscellaneous - 280 JOHNSON STREET 4/30/2018g
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MetLife Auto & Home'
Homeowner Operations Field Claim Office
Mail Processing Center
P.O. Box 2201
Charlotte, NC 28241
(800) 854-6011
March 7, 2014
North Andover Health Department
1600 Osgood St
Suite 2064
North Andover, MA 0 1845
Our Customer:
Our Claim Number:
Date of Loss:
Dear Sir or Madam:
Polly B. Pyle and Duncan S. Pyle
JDE13332 87
February 26, 2014
r 011, 6
0 rN.
mr.amofto
hAR 1 -12014
"OVVN OF NOIj7-11 ANDOVER
HEALTH DEP
'-""��ENT
Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has
been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars.
Please let us know within ten (10) days if there is a pending or existing lien against the property as
provided by M.G.L. 139 § 3B, or if there is an intent to initiate proceedings to perfect such a lien.
Loss Location: 280 Johnson St North Andover MA 01845
Sincerely,
Jeanna M. Larsen- DR
Metropolitan Property and Casualty Insurance Company
Claim Adjuster
(800) 854-6011 Ext. 7262
Fax: (855) 718-7709
Email: jlarsenl@metlife.com
Mett-ife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its Affiliates, Warwick, RI
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Commonwealth of Massachusetts
City/Town of
System Pumping Record OCT 2 3 2008 1
Form 4
DEP has provided this form for use by local Boards of Health. -Other forms may be used,lbut the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left front, left rear, left side of house. Right front,Cig-& rea
_ P, right sid( Cofho:u7�s
Address
City/Town State
2. System Owner:
Name
Address (if different from location)
City/Town
Zip Code
State�,n
-Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped
3. Type of system: El Cesspool(s) CrS—eptic Tank
Gallons
[j Tight Tank
[j Other (describe):
4. Effluent Tee Filter present? 0 YesE!r`N�o If yes, was it cleaned? 0 Yes L] No
5. Condition of System: d
V\0 � �qeu A � A
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. L fil her contents were disposed:
,9 . S.D Lowell Waste Water
. 4=1
F 5821
Vehicle License Number
of H4uor Date
t5form4.doc- 06/03 System Pumping Record - Page I of 1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
'STEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
?n �e— - I R- I ff 0 4 --
DATE OF PUMPING: QUANTITY PUMPED GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE ZZ EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY- 6a4e�g,,,
COMMENTS:
CONTENTS TRANSFERRED TO:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
Town of North Andover, MA
Watershed Septic SVstem
-servicing Report
Date: L_ L—Ttz—
Homeowner: Pumper :
Street Address: L L
Phone Phone : _
Nature of Service:
observations:
Description of Work:
Comments:
Routine
Emergency
Good Condition _4�_c
Full to Cover
Baffles in Place
Leachfield Runback
Excessive solids
Heavy Grease
Roo+ -c
Other (Explain)
M
SEPTIC SYSTEM INSPECTION FORM
ADDRESS 28c) -y-3KYvs6y--,
DATE INSPECTED (i�, 50
PROPERLY FUNCTIONING? C�) N
WEATHER CONDITIONS
COMMENTS:
WA"I"EIZ QUALuTy 'rE5-lE-r--)'Z jZG!&OL-TS�
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
I
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name 14tQ rh q It. L/ -1:4
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
/�n cesspool
0 septic tank and leaching area
El connection to municipal sewer
El other (describe)
0 do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
El yes X no El do not know -
6. How old is your sewage disposal system? El 0-5 years 0 6-10 years El 11-20 years
over 20 years El do not know
7. Has your sewage disposal system been rebuilt or repaired?
El yes X no El do not know
If yes, approximately how long ago?
years. What was done?
8. How frequently is your sewage disposal system pumped out? El annually
every 2-4 years every,5-10 years El over 10 years El never
9. Have you had any problems with your sewage disposal system? El yes no
If yes, what problems?
0 repeated pump -outs needed
El system clogs, backs up, or drains slowly
0 odors
El sewage surfaces through ground
10. How many of each appliance are connected to you r sewage disposal system?
washing machine dishwasher garbage disposal
dehumidifier drain — sump pump toilet
roof/pavement drains — shower/bathtub __LL
11. Please state the �Xand and typi.
.4 (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? yes 0 no
If yes, approximately what size?
0 less than 1/4 acre El 1/4 acre 1/2acre El 3/4 acre acre
El 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:
I 6W
Check here if your lawn is maintained by a professional landscape contractor.
Street # and Address
100 —
30
As -built? Permit #
Variances granted
System Location
KeruK (>� Roos -C
Installer
Private well
Date of evaluation Town Inspector
10-19-6q *M. C�e-,ptf
Street # and Address
As -built? Permit
-Z
Variances cranted
System Location
fKOQ-� 4 RcO �,C
Installer
Private well
Date of evaluation Town Inspector
lo- 1�-�q W
Street # and Address
1157 3,- k n a� C. a
As -built? Permit #
Variances ciranted
Installation Date
Desi iner
�,eqc
Wetland? Site Evaluator
Soil Class Pert rate
IzM
Installation Date
Designer
-Wetland? Site Evaluator
Soil Class Perc rate
S Tex6r, 3-3—IZ
-y-stem 0ocation �rista -4o-n--D-afe_--
R -, , �tO �0-1 ff 0 0
Instal.ler Designer
Private well Wetland? Site Evaluator
N 60,rboT�\O
Date of evaluatici-i Town Inspecto Soil Class Perc r2te
5--lo-H R C) S 0,,-� � I C-, ry) I �,
Street # and Address System Location Installation Date
lzq -Din
f)TCQ kf- 1� e ax,� of i i b u se I Z -30- 8T
As -built? Permit Installer Desi iner
ces granted Private well Wetland? Site Evaluator
Nf
Date of evaluation Town Inspector Soil Class Perc rate
M, G, rn
Street # and Address
/35-J—o k hn� co,
As -built? Permit #
z �
Variances granted
System 1-ccation
L - 5 id -a 01 Hoasc
Installer
Private well
N
Date of evaluaticn Town Inspector
6,9-5-8,s- M. G�KR-�
Street # and Aciclres�i
I q 0 -To k n ay CoJ(e
As -built? Permit #
Variances cranted
Installation Date
Desicner
Nut
Wetland? Site Evaluator
N '�) av-bola I b
Soil Class Perc rate
System 0ocation Installation Date
C) -f HCOL
Instal -ler Desicner
N
Private well Wetland? Site Evaluator
IN P)C& r, b Q -T � � C)
Date of ev2luation Town Inscector Soil Class Perc rate
I � - �-Y- 8q &, (�rct-� NMI 11
Street # and Address System Location Installation Date
.2557 J(3hn5oy\. 'F -Kc) -N+ Of HOONf- �--87
As -built? Permit #
y
Variances granted
Date of evaluation
7 - M- Bq
Installer
Private well
Town Inspectc
M - 6 fw-fl
Desioner
'M -e r Ki'rnc).ck clt9 Weer-)
Wetland? Site Evaluator
Soil Class Perc rate
Street and Address
System Location
Installation Date
2 to -To � n Z, oy\-
ROI& 6-f Hovse,
`7 '70
As -built? Permit #
'Installer
Designer
3enny COCO
Variances granted
Private well
'Wetland? Site Evaluator
Date of evaluation
Town Inspector
Soil Class Perc rate
, Dg��, coll
N7
16
8ry7jI
Street # and Address
21,1-1 . Jo- hn boy\,,
As -built? Permit #
V nces cranted
,j,
T,eF)6l,K to- zo-q
System Occation Installation Date
R4- bide- G�-
�-Joo
Instal.ler Desioner
Private well Wetland? Site Evaluator
1� N
Date of evaluation Town Inspecto Soil Class Perc rate
Street # and Address
2 9 0 3-0 VN vi -DON
As -built? Permit #
Varialces granted
System Location
F(ZOV,fto+
150 r, M
Installer
Private well
Date of evaluation Town Inspecto
6- ?0 YY) CkKD
Street # and Address
3 110 J-0hp3Op%-
As-built'? Permit #
/-" q 1111;�'
z
Variances granted
Designer
C - -Pox ka,�-&
Wetland? te Evaluator
Soil class Perc rate
j
System Location Installation Date
OSV WOV-se TtpalFl CA-7-�-C�3
Installer Designer
'11�
t IL K v i, rA x
Private well Wetland? Site Evaluator
P- r\ J, ol 0, -C
Date of evaluation Town Insoector Soil Class Perc rate
13 2 13 /10
EMdL
54,9-P ep,
Street # and Address
3,Z,5- — � n 5o V\ -s
j o
)�s-bullt? Permit #
Variances aranted
Date cf evaIL12tion
System Obcation
f�Or6o�
Instal.ler
Private well
Town Inspectc,
Installation Date
q - 1z -q Cf
Designer
, &- K bc,)C, 0
Wetland? Site Evaluator
Soil Class Perc rate
q P,4 I,
Street # and Address
I qq To � n ny(Ac
As -built? Permit
V2riances granted
System Location
'F,cuz of H oo)-f
Installer
I -K ci I],
Private well
T
Date of evaIU2tion Town Inspectcr
I I - - I S-�- 9 q clra�
Street # and Address
, �V) Yyc 0,kt
v5-0 3 0
As-bulit'? Permit #
Variances oranted
System Location
Y,ecxr- C) �
�40o7e—
Installer
Private wel I
, N
Date of evaluation Town Inscector
b - Y- 3:s- M . (-,). F, 0, � f
Street # and Address
2 0 1 To k n -4yx
As -built? Permit #
System 0ocatign
OF HOUSE'
Instal.ler
lr4sfall�ticn Date
Desioner
N
Wetland? Site Evaluator
Soil Class Perc rate
J q M/;
Installation Date
Designer
N
Wetland? Site Evaluator
bodbay, I
Soil Class Perc rate
5r -n
Desicner
Installation Date
10- 2-q - sl�
Variances granted Private well Wetland? Site Evaluatcr
Date cf evaluation Town Inspector Soil Class Perc rate
wc ()'I)
Street and Address System Location Installafign Date
V<eor, c -)f �-14005t,
As -built? Permit #
Variances granted
Date of evaIU2tion
Installer
Private well
Town Inspectc
C� IK 0 YrL ao�_ 0
Desi iner
2) o W -e K_
Wetland? Site Evaluator
Soil Class Perc rate
8 M
Street # and Address
System Location
Installation Date
/_ 56 J�o k �A �, 0 Y�_
R, c ck r, o o ",-P-
U - 2 5- r)
As -built? Permit-#
Installer
Designer
W D -e- � o Lk
Variances granted
Private well
-Wetland? Site Evaluator
Date of evaluation
Town Insoector
Sell Class Perc rate
C 0',
Street # and Address
System Occation
Installation Date
2_5 5 J -o k r) 5 o,�-,_ F;zo�vf 6
q-3 0-87
As -built? Permit #
Instai-ler
Designer
Variances aranted
Private well
Wetland? Site EvalU2tcr
Date of evaivation
Town Inspectcr
Soil Class Perc rate
52 o
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filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
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Commonwealth of Massachusetts
City/Town of North Andover
f LJ 5 ';J13
System Pumping Record
'4 OF t
'ro"f,
TO�71'q OF NORTH A
P, NDOVER
Form 4 LHEALTH DEPART.' -'ENT
— --a
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
1. System Location
Address
North Andover
Cityrrown
2. System Owner:
Name
Address (if different from location)
CityfTown
- �6� nz,(�n Z�- -
Ma
State
State
Telephone Number
01845
Zip Code
Zip Code
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped -
Date Gallons
3. Type of system: Cesspool(s) Septic Tank F-1 Tight Tank F-1 Grease Trap
El Other (describe):
4. Effluent Tee Filter present? F] Yes Jv� No
5. Condition of System:
6. System Pumped By:
Stewart's Septic Service
Company
7. Location where contents were disposed:
If yes, was it cleaned? El Yes El No
Vehicle License Number
755��tment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hauler Date
Signat ire of Rec i ing Facility Date
t5form4.doc- 03/06 System Pumping Record - Page I of 1