HomeMy WebLinkAboutMiscellaneous - 53 GLENNCREST DRIVE 4/30/2018 53 GLENNCREST DRIVE ve
210/104.0-0052-0000.0
FORM U - IGT RELEASE FOR1�!
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills o t this section*****************
APPLICANT: one
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street ��, o r r�ti. St. Number
************************Official Use Only****************** * **
REC0194ENDATIONS OF TOWN AGENTS:
Date Approved ----== ^
Conservation Administrator Date Rejected `
• Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
ealth Agent Date Rejected
Comments ?5/-Q IZ-Y ,AODM
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
MORTGAGE INSPECTION
BAY STATE .SURVEYING SERVICE INC.
234 CABOT ST.,13EVERLY, MA. '
LOCATION00Ytc }. � :.. NOTES =
SCALE = I" = 8D FT. DATE � .,/cvZr 9�19A? • This is a Mortgage inspection survey and not
an instrument survey,therefore this plot plan is for
REFERENCE i .�CG�.�1�:.jQ9.7j. t.���..... mortgage inspection purposes only.
.icor.dcd.Jl�.�i✓ .��� . .._.
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• This survey is based on survey marks of
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r others.
To .89.Y.X40 Nx,_;[YJpXr:0.t.F.0e :.. • Bushes,shrubs, fences and tree lines do
1 hereby certify That I have examined the premises and that the
not necessarily indicate property lines.
building(s) shown an this pton are located on the ground as • The building(s) are not located in the s ectal
shown and that they conformed to the zoning setbacks of the g p .
hl rt�i .f}n d o Y�r. when constructed. flood hazard zone,os defined by H.U.D.
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED �7'r
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
W A7 ire aZ;ALiTY fiE ►
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
rr An y b- ))Uwe lq 1)(
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Please forward us as much of the following information that is possible;
1. Type of system
2. Age
3. Uocat ion
� udy aid
4- Maintenance records and date of last pumping out
Last fP �� OA w Se P+- I / 77
5. Documentation of repairs and reconstruction
6. Site conditions
7. Builder of system
8. Engineer who approved;
— Site
— S-ystem
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9. Installation Procedure _
1_0. Problems,
y
s3 61�ercnoS-t' � r.
Andes ,
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name K1C14�d-1� r�Lt�ovlSk)
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
[A., 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 f14 do not know,
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years C] do not know
antic,o,�au� Z�- Z<_ jus. sly
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no Q,_ 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
latk a-Z.--
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 x dishwasher x garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub X
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher 1�4 �h
clotheswasher 1 14 aAw 5M,0%Z
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre Oil 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 Spu►�°�
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.
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BOARD OF HEALTH
1461ViAIN'S' tREET
TELEPHONE# (508) 688-9540
APPLICA TION FOR ABA NDOiWVENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section. 310 CMR 15.354
of the State Environmental Code, Title V
Name 14E, Z-Ekl��X,5e/ Phone
Address
Contractor (tired for work:
Name � �.! t,A�oc'-) Phone
Address (3,9 A 517 ZE�5''I"
Date for scheduled abandonment 140 L) 25.,
The septic system at the above address has been abandoned according to
Title V specifications. / 7
Signature of ntractor
Method of septic tank abandonment (check one). O removal ( } sandfill
06 crush O other
Name of Offal Hauler i"S t: �-r
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.
t
Inspecting Agent Date 17
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