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HomeMy WebLinkAboutMiscellaneous - 288 WINTER STREET 4/30/2018N t U A3 c -o '. e7 jCustomer Signature Servicemtrt C- f/ s Nature of Service N/C ��' (,(Reg. Maint. ROTC RAM INCE '1 ❑ Emergency We Use Our Heads ... To Solve .Your Septic & Drain Problems Day ❑ Night FROM THIS BELL stomer Name: Service Location: r Phone-; P.O. ox 295 • Lbwe�ll, t1g0 853 Contact: (508) 452-9022 _� e %��'� Professional Septic & Dr In Billing Address: Emergency 24 Hr. Svc. — 7 Days City: Zip: Special Instructions Completed r GIr.J CL Per: ❑ Incomplete Reason: c7'� �� ✓' C AM/PM Services Rendered /VVamPumping Tank -fes' lr Observations Good Good Condition Drain Cleaning C3Main ptic ❑ Drywell � L Runback Line ❑ Toilet Bowl 1, ❑ Leech Pit / Overflow ❑ D -Box u i1 j ❑ , Riding High (lu>�t[d evel) ❑ Kitchen Sink 0 Bathtub /Shower i� ❑ Pump Chamber ❑ Grease Trap - Ulf to Excessolids ❑ Vanity CFloor Drain 11 Catch Basin Top,/ Bottom Yard Drain ❑ Portable Toilet let `' red Soap ❑ Heavy Grease C1 -Vent d El Other Oty: ❑ hoots ❑ Sewer„ .❑Q� Size: ❑ Under, 1000 -gallons 11000 C31500 ❑ Suggest hectic Rootering F ' gallons gallons F-12000 gallons ❑ 30U0 gallons ❑ 4000 gallons ❑ Van Calms ❑ 5000 gallons ❑ other ❑ Other Misc. ❑ Digging Charge ❑ Backhoe ❑ Inspection 11 Location n. ❑ Consultation ❑ Certification: P/F ❑ Service Call ❑Estimate Reason: ❑ Labor ❑ Portable Toilet Rental ' CJ Pump Repair ❑ Waiting Time ❑ Baffle . ❑ Repair ' Digging Charge Is Per Driver L J Chemical Treatment . Discretion ❑ Other Description of Work Re3pmendations Terms of Payment Parts _ acuu Pumpi Drain CleaningTax ` WE.` 30- DAYS Month Yr. . Discount Terms & Conditions ❑ Cash ❑ Credit T } responsible ford Po r2A a beyond curb line. ` 3. 1.5 y pe, will be charged to accounts pad due. mplaints shall be r rted in hot rchaser agrees to pay all cost of collec!ko _ � Q e7 jCustomer Signature Servicemtrt C- f/ s SEPTIC SYSTEM INSPECTION FORM ADDRESS 2 VD W C ✓l G-� DATE INSPECTED K- � PROPERLY FUNCTIONING?6 N WEATHER CONDITIONS COMMENTS: WATER MALI T Y TES1Eb? 3ZESULTS? DYE TEST PERFORMED? Y N DATE? SKETCH: OF NF4L 1'F I 4 PPI7�Ov j� D1.SAPPKU V5 RQ-soNs = PA -r6' • '� z cw+�T��2 ST c4tJ I SM ►rr� SO PFu �3 FDwtJ� ❑ WEc,� �P ouC1� IYJT'L SEPI. i G SYS 1 EA A lig Si t�f� pbo) vo Gov C K 94-6 /JPNOUjN* AU1rloK►Ty Co,jQITO�J5 t'aA.) D.4 7�� 2 h6a.) 3's \ [fig V1.1" I he - V< -,e P1 i ciS 5- -t ylk SY5TtFM W SU IL A TI OA-) EYc4u4T(c►,,),J 0--i2_ 4Wi 4S E] F4iL- +'vSPEcrIO"J P( PC- F-R)A-\ Tc.s TJ O K El MS co F4)L 1PP ROVE Qi3TC)2j D►s/3Ppj�vvEp D,aTC FML APPF�DVAL Dr0 ?,f OL -,D ",` 5 u FA V��;C '1 ✓� t I ` Ir � ` r j t�•i 1 t t � I { Age ! { � T ...� �' % ��.�•i - Fel%✓i.i Ir✓./'rl.r I�5 i \I I r. tom✓. _!. i�. Lr � � r r,� .�' ' � ' I OL -,D ",` 5 u FA Julius Kay, M.D., Chairman R. George, Caron Edward J: Scanlon BOARD OF HEALTH NORTH ANDOVER MASSACHusErrs 01845 COMPLAINT REPCRT T ♦ rnim TEL. 682-6400 Omer.� . _ �1�lY�t-t�..��1. -'�t.'�'' - - - Occupant C Address Address � ,�.�.�.-.�,�/c _ DO NOT WRITE HE,OW THIS LINE Referred to `- - Date Investigated Result of investigation ) e"-0 R ecormnendatlions Action s� j is eo , cam s 4-*Qa � - 3 Ste©. 1. Name WATERSHED RESIDENTS / QUESTIONNAIRE / li"ll /� / r y z-/0,',_, /Ci /� r Z^+�/I / ! B r 2. Street Address 'W 91//�6f 3. How many members are in your household? `fin 4. What type of sewage disposal system do you have? ❑ cesspool 0 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? .56 yes ❑ no ❑ do not know' 6. How old is your sewage disposal system? ❑ .0-5 years ❑ 6-10 years 11-20 years` ❑ over 20 years ❑ do not know 7. Has your sewage disposals stem been rebuilt or repaired? [I yes El no do not know If yes, approximately how long ago? years. What was done? i justloe3Wh*i hcvve, �. 8. How frequently is your sewage disposal system pumped out? annuallye,alC?G� ❑ every 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 ap lia ce are connected to your sewage 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 o der) of detergent you use for: dishwasher clotheswasher 12. Does your property have a lawn? jai yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre ❑ % acre ❑ 3/4 acre 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. BOARD OF HEALTH 146'MAIN `STREET TELEPHONE# (508) 688-9540 APPLICA TION FOR ABA NDOIWENT OF SUBSURFACE DISPOSAL SYSTEW (SEPTIC SYSTEM) Pursuant to Section. 310 CMR 13.334 of the State Environmental Code, Title V Name Ck L3,-/APhone Address Contractor hired for work: Name 26, Phone Address 121-4 , Date for scheduled abandonment rt: 30 The septic system at the above address has been abandoned according to Title V specifications. VA Signature of Contractor Method of septic tank abandonment (check one). () removal () sandfill crush () other Name of Offal Haulerd-J 24 , 1'�) This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH J REPRESENTATIVE'S USE ONLY. Inspecting Agent Date