HomeMy WebLinkAboutMiscellaneous - 34 WILLOW RIDGE ROAD 4/30/2018i
"SoocEWER
SERVICE
JOHN SOUCY, President
GF(5
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119 West Street 9 Methuen, Massachusetts 01844 9 (617) 683-5709
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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.313
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
AVEDIS & SUSAN GARAVANIAN
06/17/03
2 4 2003
34 WILLOW RIDGE ROAD, NORTH ANDOVER, MA 01845
0654804
Ice Dams
03/24/03
199624
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139,
Section 3 B 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
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
;(NENTS TRANSFERRED TO: a�
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YSTEM OWNER & ADDRESS
SYSTEM LOCATION
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DATE:
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(exam lep ,• . left front of house)
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;(NENTS TRANSFERRED TO: a�
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YSTEM OWNER & ADDRESS
SYSTEM LOCATION
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DATE
DATE OF PUMPING:
QUANTITY PUMPED
GALLONS
CESSPOOL:
NO YES
SEPTIC TANK: NO
YES
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NATURE OF SERVICE: ROUTINE
• EMERGENCY
OBSERVATIONS:
GOOD CONDITION
FULL TO
HEAVY GREASE
_ COVER
BAFFLES IN PLACE
ROOTS
LEACHFIELD RUNBACK
. EXCESSIVE SOLIDS
FLOODED
SOLIDS CARRYOVER
_
_ OTHER (EXPLAIN)
SYSTEM,'UMPED BY:
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;COMMENTS:.
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TO: NORTH ANDOVER, MASS lZ 19
BOARD OF HEALTH
L
FROM: :� DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
4F ZZ// Ozo R.,Jrc North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans ands ecifications dated
��sErrs
19 5P� by
eg. P'� d( Urfgifie`eQReg� anitarian
TO
FROM:
\k
C,,A A
NORTH ANDOVER, MASS
BOARD OF HEALTH
DESIGN ENGINEER
Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
L Q T !A✓I/! d W & f'� �E /21-) - North Andover, Mass.
SITE LOCATION
/The grades and construction are as specified in my plans and specifications dated
'F/ 19 7G. tiP��H�- eWSs`�
eg. r f. En 4�eer/Reg: $ani'rian
GOIRD or= H&OL i 1-i
NoI�TH 4UPOVEI,�I MA,
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1
e SOIL PROFILE & PERCOLATION TEST DATA
Town City' w No.&StreetZ�
r �z Lot No.P8
Loc./ Subdiv.�&'V''O1c1 zk_lew Plan Owner
Investigator�ZC'_24a/�C_ Observer
SAq/7a
3' Elev.
o
1
2
3
4
5
SOIL PROFILES -DATE
' Elev. 3. Elev.
1
2
3
4
5
1
2!I
3
4
5
UE Xi
1 2 3 4 S
Start Saturation
=1f3
Soa%-Mins .
�
w
3
Drop of '3" -Time
Drop of 6" -Time
';-tns.lst 3"Dro
hN
b
Qi
N
N
V
U
3 6 6 G
a s s
\� o
10 10 10 1\ \�`
Benchmark Location
Elevation Datum
Percolation Tests -Date
Pit Number
1 2 3 4 S
Start Saturation
=1f3
Soa%-Mins .
Start Test -Time
3
Drop of '3" -Time
Drop of 6" -Time
';-tns.lst 3"Dro
hN
zs.2nd 3"Drop
& Sketches on Back
Frank C. Gelinas & Associates, North And.
V1.
SOIL PROFILE & PERCOLATION TEST DATA
"'u' ""4' 10/0 ue, -- ,
Town/City No.&Street Lot No.—e
Loc./Subdiv. Plan Owner
Investigator_ Observer
/
SOIL PROFILES -DATE
' Elev. �' Elev. Elev. 4'Elev.
01 0 0 0.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Benchmark Location
Elevation Datum
Percolation Tests -Date
1
2
3
4
5
6
7
8
9
10
Pit Number 1 2 3 4 S
Start Saturation
Soak -Mins.
Start Test -Time
Drop of 3" -Time ;
.D�rop of 6" -Time 0 15'
Mins.lst "Dro
Mins.2nd 3"Dro
Notes & Sketches on Back Frank C. Gelinas & Associates, North And.
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'-.=.;"�'NN.masa.gorldoFrtirelvilepprOYeJsllblorms.n:'11,71.�9�6C1 ^
Wit
Date:lo—,
Homeowner:
Pumper
Street 1
ItoI
Address:�C� m
Phone :-----i--L L!3 Phone
Nature of Servics:
Observations:
Description of Work:
Comments:
Rcutine
Emargency
Good Condition
—
Fu.'.1 t:o Cover
6
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
0th ar (Explain)
0
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.313
06/07/02
'J+RTH ANDD
_EC_ 4'7 OF HEALTH
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL 3 200
NORTH ANDOVER MA 01845
Re: Insured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
AVEDIS & SUSAN GAR.AVANIAN
34 WILLOW RIDGE ROAD, NORTH ANDOVER, MA 01845
0654804
Water Damage
06/05/02
192161
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139,
Section 3 B 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
Q
C\ Commonwealth of Massachusetts
wqa�`City/Town of -NORTH ANDOVER MASSACHUSW44
System Pumping Record ECElVED
wForm 4 IJU - 5 006
DEP has provided this form for use by local Boards of Health. The Syste r
be submitted to the local Board of Health or other approving authority. HEALTH DEPARTME�
A. Facility Information
Important:
When filling out 1. System Location:
forms on the
computer, use
only the tab key Address '
to move your fa
cursor - do not
use the return City/Town State
key. 2. System Owner:
Name
6 lqni,e
feQ'" Address (if different from location)
City/Town
B. Pumping Record
4.
Date of Pumping
Type of system: ❑
State
relephone Number
Date / 2. Quantity Pumped
Cesspool(s) Septic Tank
❑ Other (describe):
Effluent Tee Filter present? ❑ Yes ❑ No
5. Condition of System:
r ,/) - I
Zip Code
Zip Code
mob
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
6. System Pumped By:
CG
Name -r Vehicle License Number
(19
7� �{
Company
7. Location where contents/were disposed:
C)o
Q - _
Si ature of Hau Date
http://www.mass.gov/dep/water/ provals/t5forms.htm#inspect
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1