HomeMy WebLinkAboutMiscellaneous - 364 JOHNSON STREET 4/30/2018O
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BOARD O1T f-IEALTFf
146 MAIN STREET
TELEPHONE# (508) 688-9540
APPLICA 710AI FOR AB.4ADOA-."tEiVZ
OF SCABS UREACE DISPUS,IL S rS7EM
(SEPTIC SYST EV)
Pursuant to Section 310 CMR 1.;.33-1
of the State Environmental Code, Title V
Name mr f�
Address '6d
Contractor Hired for work:
Name Ir"P /12e l 'J��
Phone
1 ig TERE
roww OF pt�!h�7�",w p" v R
'OQ�I� �.
LJ r 17 1996
Phone 47 '� — l �—> 3 %
Address 2r,1
Date for scheduled abandonment
The septic system at the above address has been abandoned accordino, to
Title V specifications.
0 1
Signature ofCi
ltractor
Method of septic tank abandonment (check one). O removal O landfill
Acrush ( ) other
Name of Offal Hauler G c,��5bf1
This form must be returned to the North Andover Board of Health.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
Inspecting Agent Date
SEPTIC SYSTEM INSPECTION FORM
ADDRESS nv,•,,
DATE INSPECTED^
PROPERLY FUNCTIONING? 6) N
WEATHER CONDITIONS
COMMENTS:
WA i ER OVALiTY TES i 1-� o RESULTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
r-
Please forward us as much of the following information that is possible;
1. Type of system
2. Age ' 3 �.
3.. Location
4- Maintenance records and date of last pumping out
5. Documentation of repairs and reconstruction
6. Site conditions
7. $wilder of system
8. Engineer who approved;
— Site
-- S -y s t em
G A
9. Installation Procedure
10. i'roh] Fms
WATERSHED RESIDENTS QUESTIONNAIRE
1. Named
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
IN 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?
❑ yes ❑ no >4 do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years SZ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no T do not know
If yes, approximately how long ago?
years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ 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 appliance 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 rand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher`' �-4D
12. Does your property have a lawn? L yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn j
No. of applications per year �
Season(s) of the year n+
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.
To of North Andover, MA
Watershed Septic system
_
Servicing Report 1
Date: JUNE 23, 1994
Homeowner: MR. PANDIT Pumper : CURRIER SEPTTC & DRATN SERVICE
Street 364 JOHNSON STREET Address: 107 FOREST ST., MTDDLETON_ MA.
Phone (508) 687-8733 Phone (508) 774-2772
1
Nature of Service: Routine X
Emergency
Observations: Good Condition g
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Description of Work: '
PU14PED-AND INSPECTED SEPTIC SYSTEM
Comments:
107 Forest St.
Middleton, MA 01949
(508) 774-2772
C
pstx
CLIENT:
PROPERTY ADDRESS:
DATE OF INSPECTION:
We certify that the
6-3-94
SEPTIC SYSTEM
SEPTIC CERTIFICATION
DATE: 6-17-94
MR. PANDIT
364 JOHNSON STREET
NORTH ANDOVER, MASS
6-3-94
SEPTIC SYSTEM is presently in adequate working condition on
. We make no representation or warranty that the
will not fail at some undetermined future date. Its continued
adequate performance will depend upon several factors including:
1. The volume of use of the system
2. On going future maintenance of the system
3. The continued percolation ability of the draining area
4. Physical or chemical damage
It is determined by inspection that the
the time of the inspection.
COMMENTS:
is inadequate at
Currier Septic & Drain Service
- THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY -
Town of North Andover, MA
Watershed Septic System
Servicing Report
Date: JUNE 23, 1994
Homeowner: MR. PANDIT
Street : 364 JOHNSON STREET
Phone : (508) 687-8733
Nature of Service:
Observations:
Routine X
Emergency
rjam MIMI
MaNYMM
Pumper : CURRIER sEPTTr & DRAIN SERVICE
Address: 107 FOREST ST., MIDDLETON. MA.
Phone : (508) 774-2772
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
X
Description of Work:
PUMPED AND INSPECTED SEPTIC SYSTEM
Comments:
Am, n I. -ON
r .
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Dear Lake Cochichewick Watershed Resident,
TEL. 682-6483
Ext. 32
In order to protect the water supply in North Andover from
improperly functioning septic systems, at a meeting on June 24,
1993, the North Andover Board of Health voted to adopt a -
Watershed Septic System Pumping Regulation as published in the -
June 16, 1993 edition of the North Andover Citizen. This
regulation requires all homeowners in the Watershed District to
regularly pump their septic tanks according to a mandated
schedule.
Homeowners in your district, I.e. District 3, who are currently
using a septic system are required. to pump their septic tanks and
report this pumping by September 30, 1994. If you have pumped
your septic tank within six months of this publication, you are
requested to submit proof of the pumping and are not required to
pump again for three years.
Septic system pumpers who are licensed to haul sewage within
North Andover will be furnished with "Septic System Servicing
Reports" which must be completed and signed by both pumper and
homeowner and returned to the Board of Health at Town Hall prior
to the deadline prescribed for your Watershed District.
There are penalties for both pumpers and homeowners who fail to
comply with this regulation. Those interested may obtain copies
of this new Septic System Pumping Regulation from the Health
Office at Town Hall.
Thank You,
North Andover Board of Health
Dr. Francis P. MacMillan, Chairman
Gayton Osgood, Clerk
Dr. John Rizza, Member