HomeMy WebLinkAboutMiscellaneous - 44 APPLETON STREET 4/30/2018 (2) 44 APPLETON STREET t
210/037.6-0041-0000.0
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Address ,��' ���1� ��� S% Title of File
Page 9 of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes:
action Document/ document/
Num. Action Department
Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department
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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
07/07/99
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.3B
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: DAVID I. BRUCATO
Property Address: c44,APPLETON STREET?NORTH ANDOVER, MA 01845
Policy Number: 0441849
Type Loss: Other Section I losses
Date of Loss: 06/25/99
Claim Number: 173534
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
CWN OF Q -
BOARD C �?t6cR/
F,JUL 121999
CMA00021
�4.
s _
r STATEMENT
DANIEL A. GIARD
130A Appleton Street
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NORTH ANDOVER, MA 01845 DATE /
z.�
686
Phone -7653
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._...............__... _.................._._........................................._... ............. .........................-...........___.._....................................
•✓' TERMS:
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ 136 '
DATE INVOICE NUMBER/DESCRIPTION I CHARGES I CREDITS �m BALANCE
BALANCE FORWARD
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-. ..... ......... . .. _...... .. . .. _. . --....... --.--
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................._............................_.._._......_........................_....
72
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PAY LAST AMOUNT f
DANIEL A. GIARD ' _ � � IN THIS COLUMN
..- -- PRODUCT 10a2FA�J1�-Groton,Mm01O1.ToOrLa PHONE TOLL FREE tAD}225{3N
SEPTIC SYSTEM INSPECTION FORM
ADDRESSAf>p�4Vl\
DATE INSPECTED
PROPERLY FUNCTIONING? Q N
WEATHER CONDITIONS
COMMENTS:
14ATI ER QUALITY TESTtb n RESoi?S? .
DYE 'TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
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3. How many members are in your household? 1
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) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no X do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
IA over 20 years ❑ do not know
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
every 2-4 years ❑ every-5-10 years ❑ over 10 years ❑ never
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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 _ X garbage disposal — -
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub ,
11. Please state the brand and type (liquid ori powder) of detergent you use for:
dishwasher PC 'A. "'.
clotheswasher Q, M F 0 Q �
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 year d
Season(s) of the year �1
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
4
❑ Check here if your lawn is maintained by a professional landscape contractor.