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Home My WebLink AboutMiscellaneous - 1015 JOHNSON STREET 4/30/2018 (2)_"IT ti b Cj C) w V bz zz O m b m I Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key.. ILS Commonwealth of Massachusetts City/Town of NORTH ANDOVER MASSACHUSETTS_ System Pumping Record Form 4 AQ DEP has provided this form for use by local Boards of Health The System rumpling R ord must be submitted to the local Board of Health or other approving t NpP,tH ANDOVER A. Facility Information 1. System Location: Addres 4 ` f� Cityfrown 11 State' Zip Code 2. System Owner: LIGh+- Name Address (If different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3.: Type of system: ❑ -0 Other (describe): State Telephone Number Date W711D 2. Quantity Pumped Cesspool(s) M Septic Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped B� 7�/i r- k Zip Code Gallons ❑ Tight Tank If yes`was it cleaned? ❑ Yes ❑ No Vehicle License Number (S Em 'I kn Ct3 '16f t rrlJl� 61 • Company 7. Location where contents were disposed: _ http:/A,vww.mass.gov/deptwater/approvals/t5forms.htm#inspect t5fonn4.doa 06/03 System Pumping Record •Page 1 of 1 PAGE II STEWART'S SEPTIC TANK SERVICE (CONT'D) 04-22-96 A 31 STONE CLEAVE ROAD 1,800 201 BRADFORD STREET 11000 04-23-96 585 BOXFO.RD STREET 1,500 A 175 GREAT POND ROAD 2,000 04-24-96 1615 OSGOOD STREET 500 A 122 OLYMPIC LANE 1,500 A 1116 SALEM STREET 750 04-25-96 A 75 FORREST STREET 11000 04-26-96 550 BOSTON STREET 2,000 04-27-96 A 1015 JOHNSON STREET '' 11000 175 FOREST STREET 11000 350 SHARPNER'S POND ROAD 1,500 04-29-96 A 18 STEVENS STREET 1,250 A 100 FOREST STREET 1,500 A 82 PADDOCK LANE 1,500 04-30-96 A 133 SUMMER STREET 11000 A 347 HILLSIDE ROAD 11000 HEAVY 2-1,000 TANKS Z1QAk 1UQQ t JS UNIFORM AFFUCATION FOR PERMIT Til CO FL.UNLblrlu (Print or Type) NORTH ANDOVER, , Mass. Dais // 10 l Building Permit Location l -— Ownees Name New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No. ❑ FIXTURES � Check one: CadvIcaie J Installing Company Name �- /�l. P �d- G ❑ Corp. Address1 J/S � �U 2 J S % ❑ Partnership adzdfa u✓r—�_ 2`� r 9-Firm/Co. Business Telephone (a ,I` d'L2�-O Name of Licensed Plumber INSURANCE COVERAGE: Checx one 1 have a current liability Insurance policy or No substantial equivalent Yes El" No ❑ If you have checked 10, please indicate the type coverage by checking the appropriate box. A liability insurance pcilcy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licenses does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent E)eters o Not (aMT1N ! ens 1 hereby arUty that all of the details and information I have submitted (or enteredl In above appAeaUon are true and aoaxate to the bell of my knowiedge and that all plumbing "k and installations p*doinwd under the pe�rA I a ap tion 7 be Rance with aN pertinent provisions o1 tine Massachusetts State Plumbing Code and Chapter 11ffie d 7 BY real Tni. City/Town License Number Type of Plunbing L ansa: Master AlTriOMED (OFFICE USE ONLY) Journeyman 0 si' w s w w ! Wa Is ! « rr w N A w o S V at < ~ M s O el a .1 w A M = w F• u < a• at < at • U a < s < Z t~t s= r 0 1.-` a< y w et < sa y w 0 < a1 = a a O s r s V Y M = p Q S !- p V y is 1 N a O w el a o On a a fU•—lIYT. •AGRUGHT IST FLOOR IND FLOOR IND FLOOR 4TH FLOOR ITN?LOOP STH FLOOR, ITHFLOOA ITH FLOOR � Check one: CadvIcaie J Installing Company Name �- /�l. P �d- G ❑ Corp. Address1 J/S � �U 2 J S % ❑ Partnership adzdfa u✓r—�_ 2`� r 9-Firm/Co. Business Telephone (a ,I` d'L2�-O Name of Licensed Plumber INSURANCE COVERAGE: Checx one 1 have a current liability Insurance policy or No substantial equivalent Yes El" No ❑ If you have checked 10, please indicate the type coverage by checking the appropriate box. A liability insurance pcilcy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licenses does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent E)eters o Not (aMT1N ! ens 1 hereby arUty that all of the details and information I have submitted (or enteredl In above appAeaUon are true and aoaxate to the bell of my knowiedge and that all plumbing "k and installations p*doinwd under the pe�rA I a ap tion 7 be Rance with aN pertinent provisions o1 tine Massachusetts State Plumbing Code and Chapter 11ffie d 7 BY real Tni. City/Town License Number Type of Plunbing L ansa: Master AlTriOMED (OFFICE USE ONLY) Journeyman 0 S Date. 3235 TOWN OF NORTH ANDOVER .a PERMIT FOR PLUMBING ,SSACMUSE� This certifies that .. .. ... S! .`!'c '.` . . has permission to perform ..... ` ' ......... .................... plumbing in the buildings of ..I.(.* -/. t 4- , h.�L .................. at.f............NorthAndo� Mass.. or Fee,??......Lic. NoJ.G:.C... ......... PLU BING INSPECTOR �`p /13iS1 13.'41 M.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer t TO: NORTH ANDOVER, MASS A 19 '7 -5 - BOARD -BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at Z—o T 3 ,4 oA,, /,, Y,,, �'j S7—- North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD D.A'I E: SYSTEM OWNER &//ADDRESS j e e^'-2, - it/o _ Z-)dOwL"I SYSTEM LOCATION (example: left front of house) D:"TE OF PUMPING: - QUANTITY PUMPED GALLONS CESSPOOL: NO. J/ YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: CO'NIMENTS: CONTENTS TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) VL(VJ/1JJ� VV. JV JV VJIJVVll JIG�(HI�,1/HIVLUVGI<. r'Hl7G Clw li I BTWM S SEPTIC um samcE 47 Maar D grREST NOZM# M 01835 978-372-7471 Mon cr, cid PCR Mmor �Nd arrr� 505 pp,C f- 5A tt:5 SCS [Yl f. �i 61 /ri N s /VI5 lvoo 1 Qln St /Vs il A nem„- - a.dr�J iGi -oma µ I BTWM S SEPTIC um samcE 47 Maar D grREST NOZM# M 01835 978-372-7471 Mon cr, cid PCR Mmor �Nd arrr� 505 pp,C f- 5A tt:5 SCS [Yl f. �i 61 /ri N s /VI5 lvoo -TOM L10KTVuZ�j -T to =40` 00 q - 4V 'yM 1-1-N, 4C. 1�' 3 4i5l (go c Joseph j. barbsgallo, r.s. 1 westward circle no. resding,msss. G0 �' �-{-� , PITS �✓/48" Tiz' , ,z Ga FoR. ' �.M._ too,0 ' 2`>)fA.u.ow PITS , e 0 � To Joseph j. barbsgallo, r.s. 1 westward circle no. resding,msss. /I IV dna. ILM-lp OIZAKICi. e-'VR'c- ('44 E--oUAL 4' Jm, CA, tu `C!� ]XI UJ 3�j 71--1 [7- L --'-'Nr r -e "Z- PIT No SCALF- sin TAJ� TA jq' 1 i 00 C) C)c " 11 __9 N �O c.) N '��1 � � Y2� S1"ol.rE — `_#�►,C� �l.E"5 " r" _ 42SIDES CF= e4(4AVA.r(ou4 ". P rr"�� ') TOM LICHT�bURNA L-OT"S • �014WCaCCN GT, JoSrr-,�,H F,S, & H t L LV ! �� ►ZQ ►� N O P -T I-1 12 Aim 1 tit C.t M11� . dGT 27 1(2-7VA 1,` = 40 t �1 3 - 2 _ —177 -A,.4�a a h1AtL N rKea lb.N1 . Z\00,0 Sar i jlo7{ Tts TtUI t►t KG to y w.. 1 JG d w WSJ N ;14 4�, a c� PA 25 �1 w /jam YY �0� •�' •� T'Z,SL �A�i,s��j/ � �� log WSJ N ;14 4�, a c� PA 25 �1 d •" ... 12" Mw -TOPSOIL COVER. • oQ�a 3 WASHEOPE'AgTONE N8 ' 318 oo.+"�° o°° °+ "�g,° — 4��PERFORiATEOORANGED£RG 16"WASHED CRUSH EOSTbNEAL'%-JYt ASSop p nON f4REA 3Ci� 5' ABSORPTION BED END SECTION J a"2.0 1000 p,� J2" KIN• Colmm oC-ALLON macPrsosr,cv C,q too,o 0.SEPTIC ��`- i -&A iQom o° 0S �$ TANK �!� n►cava. ��'C,�a�� z DISPOSAL SYSTEM PROFILE C2' Assosty oN AREA ABSORPTION BED PLAN *J6I OBS. HOLE ioo. O 12 h um., iL 95•o P6 R7 aT e �o� PERC. HOLEHca, NbLE 175,0 12'�TWO sWIL PERC RATE D TEST DATE ac. -r f-� 1973 0 PERC TEST 6411)KATtEO te)MW li 40''Ay I t 0 1 �� col'i� L4D4t@ Vo11 .�; :. �i�: Y+�4/�•4f/J.1:L'.`<y.�C�/O�ifl' �7.I�i•�;A. :.+11;�,;�;•,• RECEIV �vv• � �,,:�'`', •, r DEC 0 6 2005 S Y 3'T`E N.i pomp,,, Rp TOWN OF NORTH ANDOVER HEALTH DEPARTMENT jYsreM 0 ADDU _ QR sLl .. , ,�. ..,,.._...QIJ�Nr►rY PUMPEt^ lam'—•_`�.__ . __... POUI,; N0.(D . Yds,• ... \ /' • . ' )vauc I u+A ti; 7 )1',, rV96 or 3�RVIre: xvu'riN� Ua lfA yA,nvNa. OoOD C0HlDITIUN ; r�u ►v �CiYhx �YY 0UA33 BAYyl85 IN RPO?'S.: LEUCF�1&40 KVNgn�'h 6�C�S8rY6 sOl,Jpe v�` ,� PLPODErO • �OL�DCAIVtYpY�X' OrNE;R•�XPI.,�IN �'VMM,rNi�. �VnI'�N�'y flVlNyr�xK.bU 11 . J.. Y