HomeMy WebLinkAboutMiscellaneous - 50 GLENNCREST DRIVE 4/30/2018 50 GLENNCREST DRIVE
21.0/104-C-0062-.0000.0e
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BOARD OF HEALTH
146 MAIN STREET rol rc of c 04
TELEPHONE# (508) 688-9540 �o`R' °of -,_ � '
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APPLICA TION FOR ABA1vDOhMENT
OF SUBSURFACE DISPOSAL SYSTEW 1'
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 13.334
of the State Environmental Code, Title V
Name Phone
Address t _ e✓t -
Contractor hired for work.
Name Cc. Phone
Address ' I'v
Date for scheduled abandonment 1. 1 --2-3—
The septic system at the above address has been abandoned according to
Title V specifications. 6��
Signature o Contractor
Method of septic tank abandonment (check one). O removal O sandfill
(;,X) crush ( ) other
Name of Offal Hauler v �'j
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.
VVI L3
Inspecting Agent Date
SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED -7- S
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
WA i 2:R Z;ALi i y "1 ES►-N 0LTIS
?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
Please forward us as much of the following information that is possible;
1. Type of system
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2. Age �. i y ye r
3. Locat ibr(. G C le k,
4. Maintenance records and date of last pumping out
5. _Documentation of repairs and reconstruction
6. site conditions
6_4 e_ , .I- eK r S-S
7. Builder of system
8. Engineer who approved%
u Al/'('1 G "1
— Site
— System
x
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9s Installation Procedure
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1.0. Problems
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name - -
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
X 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 X1 do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
J� 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 N' over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes X 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 6;81ddH useAarbage disposal
dehumidifier drain sump pump 1 toilet 3
roof/pavement drains shower/bathtub ;2-
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher Cawc&dam aM'Lzt&1
clotheswasher 51-OL4PIP-
12.
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre Rr 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
Season(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.
Town of North Andover. MA
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Watershed Septic System
Servicing Report
P WE-N 0�-'
Date:
_9
Homeowne Pumper
GIARD
Street : S o � Address: —�QrE�
SEPTIC SERVICE
Phone 8 ) 1 Phone NO,ANDOVER, MA
4�
Nature of Service: Routine ✓
Emergency
Observations: Good Condition
Full to Cover /
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
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Description of Work:
Comments:
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