HomeMy WebLinkAboutMiscellaneous - 79 GLENNCREST DRIVE 4/30/2018N
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Please forward us as much of the following information that is possible;
1. Type of system
2. tine
3. Locat ion _
4. Maintenance records and date of last pumping out
Documentation of repairs and reconstruction
6. Site conditions
7. BJAlder of system
8. Engineer who approved;
— Site
— System
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9. Installation Procedure
1.0. Problems
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street AddressMR JA L
79 GLENCRESTZAR
DRIVE
N ANDOVER, MA 01845
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
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 ❑ do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
K] over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes X 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 ❑ over 10 years ❑ never"
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 dishwasher _ I garbage disposal 0
dehumidifier drain 6 sump pump toilet +--
roof/pavement drains _6 showeribathtub `L-
11. Please state the b nd aAd type (liquid or powder) of detergent you use for:
dishwasher • :(,
clotheswasher
12. Does your property have a lawn? Q( yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 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 L
Season(s) of the year
14. Please state the brand and a (liquid or ranular) of lawn fertilizer you use:
_ tYP q g
❑ Check here if your lawn is maintained by a professional landscape contractor.
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STATEMENT
DANIEL A. GIARD
130A Appleton Street 4
NORTH ANDOVER, MA 01845 DATE •
Phone 686-7653
TERMS: Q0+
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ / Y V -
DATE INVOICE NUMBER / DESCRIPTION CHARGES ` CREDITS BALANCE
BALANCE FORWARD
TA
(C_i�
DANIEL A- GIARD 'Y&w PAY LAST AMOU
IN THIS COWM
SEPTIC SYSTEM INSPECTION FORM
ADDRESS T9
DATE INSPECTED
PROPERLY FUNCTIONING? (2) N
WEATHER CONDITIONS
COMMENTS:
DYE TEST PERFORMED? Y N
DATE?
SKETCH: