The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 536 FOREST STREET 4/30/2018 r 536 FOREST STREET Ct j� : Commonwealth of Massachusetts City/Town of System Pumping-Record Form 4 DEP has provided this form for us&by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using-this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left4Qfr nt o , Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address - City1rown State 77 Zip Code 2. System Owner. R RECOVED Name' Address(if different from location) foylij eF NGP.7W HEALTH DEPARTMENT City/Town ' State ZipSide Telephone Number 1 B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons r 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yap o If yes,was it cleaned? ❑ Yes ❑ Na ' 5. Condition of• to � � ��•/ 6.- System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo t' - ere contents were disposed: Cx._ S. Lowell Waste Water '�-2 Sign Haul Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 THENORFOLK 131113HA GROUP@ February 19, 2015 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1587201 Insured: GARY LETOURNEAU SUSAN LETOURNEAU Address: 536 FOREST STREET, NORTH ANDOVER, MA Policy No.: F0101848 Loss Date: 02/14/2015 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. @ Fax:(781)329-1818 Commonwealth of Massachusetts _ City/Town of '� � System Pumping Record J1 0 2013 Form 4lug TOWN OF NORTH ANDOVER DEP has provided this form for us&by local Boards of He HEALTH EPART ed, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/RafrQ t of Nous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address . — � Citylrown State Zip Code 2. System Owner. Name V Address(if different from location) City/Town Stater r Z* Telephone Telephone Number `-C t� B. Pumping Record L 1. Date of Pumping p g Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi v\ 6. System Pumped By.- Neil y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo . • where contents were disposed: .. S• Lowell Waste Water Sign a Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of i System Pumping Record rAY 16 N11 Form 4 TOWN OF NORTH ANDOVER A H DEPART ENT DEP has provided this form for use by local Boards of Healt . eery , but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of house;-ri"gj t frQ6t of-nous , ft side of house, right side of house, Left rear of house, right rear of house, le side of building, right rear of building, under deck. Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zi Code Telephone Number B. Pumping Record _ 1. Date of PumpingDate 1 2• Quantity Pumped: gallons 3. Type of system: ❑ Cesspool(s) , "Sep lctict Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No � 5. Condit'R n of'System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Loocatio— here contents were disposed: /G.L.S. L Awell Was W ater Signat e o rH ler Date i t5form4.doc•06/03 System Pumping Record•Page 1 of 1 ILR Commonwealth of Massachusetts ECEIVED City/Town of APR 2 8 2008 \\Q System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Locatio�ln: forms on the computer, use only the tab key Address to move your cursor---not Gityrrown State Zip Code use the return key. 2. System Owner. Name ISI Address(if different from location) City/Town Stab��. ,=J� Zi Code Telephone Number lam(rfi B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes E4-19—o— If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Syste Pu pq Name Vehicle License Number Company 7. Location erententr osed: Signatur of au Date t5fonm4.doc-06/03 System Pumping Record a Page 1 of 1 Add ress � � — Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of DocumeEnt/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department 'oi unonwea lh of Nlassacl�usetts v , Massachusetts •. astern f'urnping Record System Owner System Location T Quantity Putuped: 8allonts Date of Pumping: Cesspool: No Yes U Septic Tank: No U Yes J System Pumped by: ctt'e4ort r'finel�ftme4 License# Contents translerrred to : Greater Lawrence Sanitary Ulstrld Date: Inspector: TO'Vkli%l,OF NORTH F B{'A4� MAY J 1 1999 x� . i I ! i i I v i I I �I i 536 516�� 3 3411 I500 GALI.O►U TANK O, I $TRS UTlbN OX NEW ao`x 140 ' l-F-ACrTF-LD +I I TELEKnN E Poll` J FO RUT ST �I -MNS i Hv G- NEW LEACH BATESON ENTERPRISES. INC. LXA104--* E16 FORE .ST ARQILLA RD. MOM ANDOVERS, ANDOVER, MA 01810 --- - -- OWNER:MR.&ARY LETovRly Au ' W : APRIL_ a7 1990 FOIW 4 - SYSTEM PLA UTNG RECORD Cotntnon«vealth of Massachusetts Massachusetts System Pumping Record System Owner Nystern Location Date of Pumping �� S Quantity Pumped: • t Cesspool: No Yes ❑ Srntir Tanl•• NI , Yes System Pumped by.- License #: Contents transferred to: Date Inspector