HomeMy WebLinkAboutMiscellaneous - 400 DALE STREET 4/30/2018 400 DALE STREET ~1
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Address 6 Title of File
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Action De artment
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Board of Appeals — Board of Health Planning Board ; Co
nseruatiion commission — Building Departnlen�t
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STATEMENT
DANIEL A. GIARD
130A Appleton Street r-t;)l_p3
NORTH ANDOVER, MA 01845 DATE
Phone 686-7653
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TERMS: G
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE
DATE INVOICE NUMBER/DESCRIPTION CHARGES CREDITS BALANCE
BALANCE FORWARD
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� lYW PAY LAST AMOUNT
v IN THIS COLUMN
DANIEL A. GiARD PRODLICTI00-2,a'Inc.Groton,Mass 01471.To Order PHONE TOLL FREE 6806445-6UG
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS:
MATER QUALITY TES 1 tb n lzeso rs?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED 'RESIDENTS QUESTIONNAIRE
1. Name r 0 �? 1� tLD
2. Street Address % 00 .01q L t�
3. How many members are in your household.
4. What type of sewage disposal system do you have?
❑ cesspool
'septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Ar the plans (drawings) for your sewage disposal system on file with the Board of Health?
A
❑ no ❑ do not know.
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
Y over 20 years ❑ do not know
7. Has your sew_a�."isposal system been rebuilt or repaired?
❑ yes LV no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. H94 frequently is your sewage disposal system pumped out? ❑ annually
IV every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes o
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 f dishwasher / garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains showeribathtub 1/-
11. Please state the brandand type (liquid or.powder) of detergent you use for:
dishwasher is W'1 e i---
clotheswasher C c> d E� /—
12. Does your property have a lawn? [p' 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?
No. of applications per year
OSeason(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.