HomeMy WebLinkAboutMiscellaneous - 30 GLENNCREST DRIVE 4/30/2018c
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BOARD OFHEALTH
146.MAIN STREET
TELEPHONE# (508) 688-9540
APPLIC.4 TIO,,V FOR ABANDOA�k1ENT
OF SUBS( -,'RFA CE DISPOSAL SYS TEW
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
Name Phone—
Address
Contractor hiredfor work:
Name �6; VL 1 C4 1, 6( Phone
Address 11)0
Date for scheduled abandonment 1�k- rz
The septic system at the above address has been abandoned accordmi 'g to
Title V specifications.
4Siature of ontractor
Method of septic tank abandonment (check one). removal sandfill
(,)�crush ( )other
) I I a '5 e I -
Name of Offal Hauler 4
Thisform must be returned to the North Andover Board of Health.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
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Inspecting Agent
— if -rz:lpa
Date
SEPTIC SYSTEM INSPECTION FORM
ADDRESS '56, co
DATE INSPECTED 'T
PROPERLY FUNCTIONING? 6 N
WEATHER CONDITIONS
COMMENTS:
W A 'i E P, A L I T y E.S —I- �
t7- R
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name Francis J. Buckley
2. Street Address 10 Gleancrest Drive, North Andover, Mass.01845
3. How many members are in your household? Two
4. What type of sewage disposal system do you have?
0 cesspool
:91 septic tank and leaching area
0 connection to municipal sewer
[I other (describe)
[I do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
yes El no El do not know.
6. How old is your sewage disposal system? El 0-5years 6-10 years El 11-20 years
TO over 20 years El do not know
7. Has your sewage disposal system been rebuilt or repaired?
El yes 11 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? 0 annually
every 2-4 years El every 5-10 years El over 10 years EI never
9. Have you had any problems with your sewage disposal system? yes no
If yes, what problems?
El repeated pump -outs needed
El system clogs, backs up, or drains slowly
El odors
El sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher garbage disposal
dehumidifier drain sump pump toilet 2
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher Cascade
clotheswasher H. D * ALL
12. Does your property have a lawn? yes El no
If yes, approximately what size?
0 less than 'Aacre El 1/4 acre X:1 1/2acre El 3/4acre El 1 acre
El more than 1 acre (Specify) — acres
13. How often do you fertilize your lawn?
No. of applications per year 2
Season(s) of the year Sring & Fall
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
Scotts Turf Builder 28-1-1 Lawn Insect Control Plus Fertilizer 28-6-4
El Check here if your lawn is maintained by a professional landscape contractor.
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