HomeMy WebLinkAboutMiscellaneous - 490 DALE STREET 4/30/2018 / 490 DALE STREET
210/064.0-0011-0000.0
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FORM 4- SYST-N1 PL11PL\G RECO
TO r t4 OF AND
JUN L 19
Commonwealth of Massachusetts
, Massachusetts
System Pumping Record
vstem %vner ystem Location
Date of Pumping: Quantity Pumped: 1 allons
Cesspool: No ❑ Yes � Septic Tank: No � Yes ❑
System Pumped by- _ License #:
Contents transferred to:
Date
Inspector
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name 114 h ( 5 CIO O�_v e /
n 2. Street Address 'Ll 20 J)4'/,.
3. How many members are in your household? '7
4. What type of sewage disposal system do you have?
❑ cesspool
L� 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 C1 do not know
6. How old is your sewage disposal system? X 0-5 years ❑ 6-10 years ❑ 11-20 years
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? 3 years. What was done?
A7� ;
W QSt ✓mc,4 y- /(,e,e ' rvly f rPjC[..
8. How frequently is your sewage disposal system pumped out? ❑ annually
O [K every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes J31 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 O dishwasher 1 garbage disposal
dehumidifier drain O sump pump toilet Z
roof/pavement drains Q shower/bathtub
11. Please state the brand ad type (liquid or powder) of detergent you use for:
dishwasher 06 5 e q 7-e ,
clotheswasher lAL, K L t 4 d
12. Does your property have a lawn? ® yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre X 1/4 acre ❑ % 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
Season(s) of the year SIS!-i n 4` Eu r/v 5y aH r
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
L/(��Q f () I u/�S i rl eh f. y i`O SCS i Nt n v ••
❑ Check here if your lawn is maintained by a professional landscape contractor.
SEPTIC SYSTEM INSPECTION FORM
ADDRESS 96 Dal
DATE INSPECTED
PROPERLY FUNCTIONING? V N
WEATHER CONDITIONS
s
COMMENTS :
•
WATER QUALITY TES T F-t, ': Resw—Ts?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
Address ?,C> 1 &.L S l Tile of File
Page — of
Date t=ile Open:
------ Date file closed:—
Doc
Document/Action Title Date of _
action 6tef'sr to other Purpose of lJocument/fiction and notes
Document/ document/Num. --
Action De artment
---- ---
Board of Appeads - Board ofHel h Plannni . o _ ��
nseruationComioamissn — Building Departrnen;t
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INVOICE Bateson Enterprises Inc. Tel. (617)475-1474
formerly Rey Fortune
111 Argilla Road • Andover, Mass. 01810
Sold to '�"y� _ 19 YJ
SIZE DESCRIPTION UNIT TOTAL
500
1000
1500
2000
2500
r AMOUNT DUE
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