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Home My WebLink AboutMiscellaneous - 43 LISA LANE 4/30/2018 WEEMMMMUMNEW 43 LISA LANE 210/098.A-0050-0000.0 WATERSHED; RESIDENTS QUESTIONNAIRE 1. Name . t?Nl9 (k). 2. Street Address �T6 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. Are the plans (drawings) fo!r.your sewage disposal system on file with the Board of Health? ❑ yes ❑ no 0 do not know.. 6. How old is your sewage disposal system? ❑ 0-5 ears El 6-10 years El 11-20 years El over 20 years El do not know ;Z 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes ❑ no ❑ do not know If yes, approximately how long ago? / years. What was done? 8. How frequently is your. sewage disposal system pumped out? ❑ annually I� ❑ every 2-4 years ///A ❑ 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 showeAathtub 11. Please state the brand andtype (liquid or powder) of detergent you use for: dishwasher �' S1°tt�l.� clotheswasher 12. Does your property have a lawn? 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 yf ar Season(s) of the year — 04 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. Date. ..,�/.: .�1. . .�. 7. . . . Of ,O oTH TOWN OF NORTH ANDOVER 0 O D PERMIT FOR GAS INSTALLATION sy C SAGHUSEt This certifies that . . . . . . �`r. �.�� .�.. . . . . . . . ./ . . . .`.... . . . . . . has permission for gas installation . . .D//r/. . . . . . . . . . . . . . . . . in the buildings of . . . ..E .,l<�r.i' . . . . . . . . . . . . . . . . . . . . . . . . at . . . .. . . . . . . . . . .. North Andover, Mass. Fee.--2 .)... .-. . Lic. No. .? . . . . . . .. . GAS INSPECTOR Check# i 4199 MA.S,SACHUSEM UNIFORM APFUCATON FOR PERNHr TO DO GAS FMING (Type or print) Date NORTH ANDOVER,,MASSACHUSETTS Building Locations / / �� Permit## �7 Amount$ Owner's Name New❑ Renovation 0 Replacement 0 Plans Submitted &6 y °� ce o °o w zCLI Q c9E� z H z z C4 f., w 0 O w E+ U ) vi aat 0 o 3 a a r�i a a SUB-BASEM ENT ,y B A S E M ENT 1ST. FLOOR t� lND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH. FLOOR (Print or type) ' � W o e: Certificate Installing Company Name /f/ i_rco Address oAe � jT D IL , ❑ Partner. 8 usmess a ep one Firm/Co- Name of Licensed Plumber or Gas Fitter_ ai�, INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes Noo If you have checked yes,ple±1:ipdicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity M Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signataraeon.this permit application waives this.requirement. Check one: ❑ Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: �gnature of Licensed Plumber Or Gas Fitter Title Plumber �� Cityrrown Gas Fitter License ung er �NIaster APPROVED(OFFICE USE ONLY) Q Journeyman _ f�Mc�.�wq /� -- • a- %,rrrr%j"wt HNF'LK;AIIUN FOR PERMIT TO DO GASFITTINQ nint or Type) NORTH ANDOVER, Maas. Date_ -7- 3 Building Permit A/ Location L 3 L ; /I M Owner'a �A a Name /lye,-s New Renovation ❑ Replacement ❑ Plana Submitted: Yes [] No n rso ; „ z d -j M W h v tl H x M o ac 1.. s a: a a o s 0: w ~ Cso L h r Z ,r > iC a z 11< i 0 o o i � s o e � sti � Ile, o � s v aoe. y o aF o sue—aarNT. •AIRMENT IST FLOOR lND.FLOOR I SRO FLOOR 4TH FLOOR aTH FLOOR i ITH FLOOR e TTH FLOOR , GTH FLOOR C Check one: Certificate Installing Company Name _G.:gs;torn Corp. Address 131 Wn,cr - _ Partnershlp ❑ Firm/Co. Business Telephone - S6 F- 27y- Name of Ucensed Plumber or Gas Fitter INSURANCE COVERAGE: :Chene I have a current Ilablllty Insurance policy or No substantial equivalent. ' Yea No ❑ K you have checked yes, please Indicate the type coverage by checking the pp opriate box. A liability Insurance policy f) 1 Other type of indemnity ❑ Bow ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Vgent Owner ❑ Agent❑ I hereby certify that an of the details and Information I have submitted(or entered)In above application are true and accurate to the best of my knowledge and that ah lumbing work and Installations performed under the permH Issued or this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 112 of the ws. T of Ucense: r—1 Title L-Lnumber na so nse umber or as er Gasfiltet �y[T� aster nse Number . )Journeyman APr'nowo(OFFICE USE ONLY) /- . i/ Date. . . . . . . .. . . . . . . HORT TOWN OF NORTH ANDOVER OF t.�E o:r#.gti0 �� ht o<p r= PERMIT FOR GAS INSTALLATION lo K Z P �9SSACrHUS'- This certifies that . f- r. . . . . . .. . . . .. . . . . :'%i. . . . . . . . . . . . . . has permission for gas'installation •.-. .�.. . . . . . . . . .)'-. . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . .. s. . . . . .`' . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. ..!'. . '. Lic. No.r.! . . . .f., . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Trep-