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HomeMy WebLinkAboutMiscellaneous - 712 GREAT POND ROAD 4/30/2018 (2)BUTTERWORTH & O'TOOLE, INC. P.O. BOX 8294 SALEM, MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE (978) 741-5731 July 06, 2001 FAX (978) 740-9109 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building'Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/.Town Hall ADDRESSES North Andover, MA 01845 RE: Insured: Ronald Herskowit Address: 712 Great Pond Road North Andover, MA 01845 Policy No.: H0000085605 Loss of: 07/05/01 File or Claim No.: 17-1377 City/Town Hall North Andover, MA 01845 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, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B 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. 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 we will recommend to the insuring company that this claim is paid. Tciv VN OF OR�RAI�Lt ROADavid Vincent 'DO Vincent #Adjuster JUL 9 2001 4 COML'ANY : Ivy, IGC tY V►y _�,..c9�'�' ��'�%c/ f � � .�l L+ DATE NAME. ADDRESS Munni: As -by 11fel" _— I DESTINATION CALL. S -- Signed: oLm---r✓ E/ �^ Date: —� = In %! C�i-dP l / c32d poi �� S - ( W6 TOWN Of 110RS Lir BOARD Of HEA o Signed: oLm---r✓ E/ �^ Date: —� = WATERSHED RESIDENTS QUESTIONNAIRE 1. Names ��i�! '. S. =eel; 1 i•� ,-'�(;/1) r ai.j i rz i ) 2. Street Address O3. How many members are in your household? 4 What type of sewage disposal system do you have? ❑ cesspool Itz 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 P do not know 6. How old is your sewage disposal system?] Y 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 Q 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 O ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years �, never ; IL ''xT 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 l ✓ dishwasher 1✓ garbage disposal _ dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or owder) of detergent you use for: dishwasher _�S S �:.— � � tsA* 1-7 ,Sr ►7e <-) clotheswasher �- 12. Does your property have a lawn? E dyes ❑ no If yes, approximately what size? y/ ❑ less than 1/4 acre ElCJ 1/4 acre 1/z 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 _ 5z, O Season(s) of the year i 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: Q Check here if your lawn is maintained by a professional landscape contractor. SEPTIC SYSTEM INSPECTION FORM ADDRESS --717- Gr, ,- -- 6✓L DATE INSPECTED -'� PROPERLY FUNCTIONING? Y) N WEATHER CONDITIONS COMMENTS: WATER QUALITY TESTED? RESULTS? DYE TEST PERFORMED? Y .N DATE? SKETCH: '. Board of Health SEPTIC 'SISTEK North Ando9er'MaBd. IN STAILATI CK CHECK LIST LOT ' j_ (mid 61W 1 .! ; P OVED DATE 1i DISAPPtROTED AVATI(�i OK FAIL , easonst , f 1� 1 OK r to 10 45 1. Distance Tot a G' a. Wetlands , b. Drains 'c.. Well , t 2. Wat ar mine Location 3. No :'PC Pipe 4. • tic Tank a. Fess --Length & To Clean Out Covers �'. b. .;:'ement Pipe .to. Tank - On Both Sides of Tank -. 5• Distribution Box — -T-- a. :Covera k B.oic - No Cracks .' ' b.' All Lines ' Flo -Ring Equal Amounts C. No Back Flow 6. ' Leach , Meld or Trench 3 a. , Dir6ensions b. Stone Depth c: Capped 'Eads d. Clean Double Washed Stone t 7. LF -tch Pits F. a. Dimensions b. Stone Depth �. c. Sp' .sh' Pads d. Tees ,;, • e. Cement Pipe to Pit - Both Sides f. 'lean.Double Washed Stone f 8. No. Garbage Disposal 9. -Ar. al Grading Inspection i. 10.' Barricading Covered . System is 11. As Built Submitted a. Lot Location b. Dimensions of System CO Location xith Regard -to, Pere Test d. 'Elevations, e: Water Table 1i ainleuolS ,x 1 lue3liddy �— sl u0113esuejl s141 sall!IueP! 4314m Jagwu: %uawnoop 041 'puel paJals!oa11 + sl uopoesuejl sly, sallguapl yolym jagtl•*iu luawnilsul ayl 'Puel paPJO W 11 t oe uI A}ieloid a oa11e e 4110 01 10 uo 041 ul palou uaaq sey uo 8uo! ! uo fe�auaJ41!m eoue �o� 61 pue 10 tilsload oyl 1e popooei u0eq sey jegwnN ol!A t tt_ a loeloid e4l jot suoRlPuoo 10 Japio 0141 legs pasinpe oq aseald i of �4uoWnV Oulnssl, .......................................................... '............................................ -- ................................................................................................ _. 'IJoM 10luawoouaWwoo 01;oljd 04101 llwgns PuG Gull P91101) uo 40e10Q s lueolldcle oql pue uolssiwwoo vope/uosuoo aql of tionlloP puey J01!ew paippoo Aq luas oq awll owes a4,1011e4s lsonbal e41 10 Adoo y 'japjo s141 to oouenssl to elep o41 waal sAep ual u1411M luawliedaQ eql of tian!lap puey J01!uw palllpoo Aq opow sl lsonbei oqj Oulpinoid 'iopio OulposiodnS a onssl of Ouljaaul0u3 A!leno IeluaWualnu3 10 luawpedoo eql lsanbej of l4Ou j!ag110 pall!lou AgojOy aje paleool s! puel yons yo14m u! umol io p!o eql to sluap!saj uol Att jo ouop eq of s! Tom pasodoid ayl 4olym uodn puel a141 Ouipnge puel jo jeumo Aue 'japio s!ql Aq POADIJ609 uosiad Aue 'jaumo eql 'lueolldde oq j sajldxo uolssiwwoo Aw cilgnd nJeloN •peap pue lou aaij Jay/.,!y se awns ayl palnoaxa ays/eq 1041 pal+pal, ouXoe pue luawnilsul Bu!o6ajoj aqj polnoexa oqm pue ui paquosap uosiad oql eq of umou){ ow o; S U a t_ u�, A L L !-L1 pajeadd©1Cllcluosiad ow ajojaq' �"-6 L apg3150 jo Aep 'r sT s!y, u0 'uoissil.uluo'J u011enJasu03 ayi jo Apjojew i Aq pau6is aq jsnw jap p s!yl l i R + (s)amjeubig uoissiwwoO uoilenJasuoO xandpuV LjgJOM1 �8 panssl ,� ZOO- 1172 Pard of Health -AndoveryMass APPROVED Provided: t11, U5,- °` Title V Reg 2.5 Reg 6 Reg 10.2 Reg 10.4 SUBSURFACE DISPOSAL MIGN CHECK LIST LOTGr� t �� tt6vRon Mau DISAPPROVED DATE____.__, Reasons:�v S D4a 1-29 The submitted plan must show as a minimum: a) the'lot to be served -area, dimensions lot #,abutters b location, 'and log deep. observation holes -distance to ties c location and results percolation tests -distance to ties d design calculations & calculations shoring required leaching area e) location and dimensions of system -including reserve area f) existing and proposed'eontours g) location .any Bret areas Athin 100' of sewage disposal system or disclaimer-cheek,wetlands mapping h)'`surface and subsurface drains within 100' of sewage disposal systern,,or: discer location any drainage easements vithin 1001 of sewage disposal system or'ditclaimer-Planning Board files ;j) known sources of water supply within 2001 of sewage disposal � system or, -disclaimer ;h) location of any, proposed Well to serve lot -100 L* from leaching facilit3 ;1) location o£ Water lines on property -101 from leaching facility )r) location of benchmark ,n) driveways ,A�) garbage disposals PVC to be used in construction ;q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations r) maximam ground water elevation in area sewage disposal system ;s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks a) capacities -150)6 of flow, water table, tees, depth of tees, access, pumping b) al'aanout c) l0i from cellar wall or inground swimsdmg pool d) 250 from subsurface drains Distribution Boxes a) slope greater th 0.08 b) sump ws a LiaAla .ka AGe orG FpLT H OF ,�9� s JOSEPH 9y J G BgRegG • �� i ,END Gir✓�,, •is.aa . � � �"�.�""..�,_._ FpLT H OF ,�9� s JOSEPH 9y J G BgRegG • �� i �° _ ^ l Owl F„'!%�y.. 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