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HomeMy WebLinkAboutMiscellaneous - 116 CHRISTIAN WAY 4/30/2018 (2) t. � i Commonwealth of Massachusetts = City/Town ofti Ulu, SEP 2 5 2006 System Pumping Record Form 4 TNN C7 ,F DEP has provided this form for use by local Boards of Health..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 Location: forms on the computer,usej only the tab key Address to move your cursor- not City/Town State use theretetum � p Code .key. 2. System Owner. Name Address(if different from location) City/Town State C. Telephohe Number B. Pumping Record - 1. Date.of Pumping Date 2. Quantity Pumped: Gallons .3. Type of system: ❑ Cesspool(s) D—Septic Tank ❑ Tight.Tank ❑ Other(describe): 4. Effluent Tee f=ilter present? ❑ Yes No If es, was it cleaned? Yes Y ❑ ❑ No 5. Condition of Syste m: 6. System Pumped c F� a, Name Vehicle License Number Company -- 7. Location ere conten we posed: Signa e or Date http://www.mass.gov/dep/w er/ pprovals/t5forms.htm#inspect t5form4.doc•003 System Pumping Record•Page 1 of 1 Address b CfiJ Q l___AA/ WAY- Title of File Page of Date File Open: ------ Date file Closed: Doc Document/Action Title Date of action Refer to other Purpose of 17ocumernt/Aeon and notes Document/ document/Num. --- Action De artment Board of Appeals — Board of Heal h Plannan,g Board ; Cans ervatiion Commission — Building Departrnen;t TOWN OF SYSTEM PUMPING RECORIJ SEP 1 6 2005 DATE: �� TOWN OF NORTH ANDOVER HEALTH DCE'ARi' ,t\,'T SYSTEM OWNER& ADDRESS SYSTEM LOCATION ell(- l ,f (example:left front of house) DATE OF PUMPING: QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) �ac�o� 6utS-C l DATE OF PUMPING: _ 02 QUANTITY PUMPED : _ GALLONS CESSPOOL: NO YES EPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: . ` CONTENTS TRANSFERRED TO: Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record SEP 0 8 2009 Form 4 " TOvv!N ur- NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Othe E T E T th 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 side of house, Right side of house, Left front of house, Right front of house, Left rear of house i rear of hous Address L t �� aC-C-�w OJAC Citylrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town State q� -Q n jqe Telephone Number B. Pumping Record 1. Date of Pumping ✓�T 2. QuantityPumped: (`"��� p g Datep Gallons 3. Type of system: ❑ Cesspool(s) —eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [ado If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of S��� . ` k � ��/v 4� 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Location where contents were disposed: . .D Lowell Waste Water 5 n ur of Haul r/--- Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 ('o47=zassachusetts sachusetts " System Pumping Record System Owner System Location C C,60 Pi Date of Pumping: l Quantity Pumped: `j gallons Cesspool: No T Yes Septic Tank: No LJ Yes System Pumped by: Fcttedea git&"t�WW License# Contents transferrred to : Greater Lawrence Sanitary District Date: __ Inspector Commonwealth of Massachusetts , Massachusetts System Pumping Record System Owner System Location day c vi Date of Pumping: C —� �{�� Quantity Pumped: l�c,�-_gallons Cesspool: No Yes [I Septic Tank: No [] Yes++-- System Pumped by: 64&4dw License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: JAt� I R aF NFCL►F I.GT 1 H I 1 11 N LA Nd►��N Atil�V�1�� MA, ApPL C4k bwt-j D WELL �P�oucD1�4T'C Ss stPT'Ic Sys►�,�, v�-sic-� APNUNG Aurho►?iry �o�vIJ�T�oN5 ��'YOAv 6-Zo-t7 O•t-, r Pit�oc��L - Covr�vh' LINES D 36 J.0 si%j LLA7'«AJ YG/�U/JT(�1J )�.�c ,�G►iO�J V/JrC 5S Q F4IL. FINAL I V5PF�TloAj APPROOED D/STC ©-ZI-�7 /SP�Jr�nvc�vG +tol�►Ty je' . 1 .4D�iT�o�,4L l�jsFb::-:', jo^jS DcSl�PPKovEV D,arC tvs FV AL APPI;�pVAL cN ' r �y �ci;Tlra(., Fr.0 II L Vol El wATIDr.S --T rt.tl 17210 spo ..r Sri �< < t�7 r .LOQ fi F r IEy.(i� t '1 �4 w 1 i LOT_ 7 SFV,FRAGE Df5KI-Af_ S)S 1, AS Lt ILT _ L`C' �T!C� ,N LL '..)T t Cp I-�E I ST,/'f` �'.IA—)y r— r CY TI T•` 7t SE-1 >lSr! v16 r I_LF �S �'�,'.�T�I'-, PLAN �.L'I R � IS N'T &i'F[Xr_l AS A V, RW, OF TF;t 5)STEL [BATF 10-19-�n f' SC,AI C f " 40, PPC PARED EY ssc PC . r X10 B ,� c 1 - i Commonwealth of Massachusetts ovt Executive Office of Environmental Affairs N of Ro NkkeP°M Department of tomaoP Environmental Protection o William F.Weld Governor Trudy Coxe Seeretery,EOEA David B. Struhs Commissloner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: tl& 6%fl SIAOct, P . AJoUar^ddress of Owner: Date of Inspection: 9_ 30--cls( (If different) Name of Inspector: NQ`t i S- �`1ke S",-N Company Name, Address and Telephone Number: �&gnl -MC,_�C ,SQS �Lr ui /� �c- �'i. C4 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes �nditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: -- Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Depariment of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTE CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate ye), no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 ;�Prinled on Recycled Paper J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: (f �G7 taw\(` 5�\QAA- llj Owner: �k0.S3S Date of Inspection: �7fo- RS e]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): j�V�Q�' `�CJC�- \A e '� broken pipe(s) are replaced (� -ebstruction is removed �(V -3vQ�-) -p distribution box is levelled ore laced 'Cl1 _ The system required pumping more than four times a year due to broken or obstructed- pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions oxio which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ 'lln ��>�r��� i�<�� .� >rl�ii� ia��i. a;.., SOi! aJ50fpilOn 5)'stc^l and IS within 100 feet t0 a SUrfaC�, \1'ee! $Urf)t}' or trll?U!?ry t^ 2 surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The sysien, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1 ' l , CERTIFICATION (continued) Property Address: L �C? ��f SkA«� �/"�'"� U� Owner: ul'b C �CtS �X115 Date of Inspection: ct_ ��,-- DJ SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. 90rioltad pumping more than 4 times in the last year No Z due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no aeeeptablo water rterality analysis, If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply 1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11(v G�r���� 1j-/�"`-" UQ/<- Owner: �pt a `0's v5� Date of Inspection: q`�rj51 Check if the following have been done: '! Pu ping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates ZAAs ' g that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ uilt plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ✓Th system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. The 1/Al system components, excluding the Soil Absorption System, have been located on the site. V_Th_ septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. V The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility ov,ner land occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: tic, C,�nr�v �' A�( Q Owner: V>uuc ka"F, Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: �f'1O all ns Number of bedrooms: Number of current residents:—V-- Garbage esidents:Garbage grinder (yes or no):4y-5 Lpondry connected to system (yes or no):�rJ t Seasonal use (yes or no): c9 7 17 .5 o Water meter readings, if available: G~`�Lf 4 o-2-5 Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: Rallons/day Grease trap present: (yes or no)_ Indiostrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ 'Vater meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as pan of inspection: (yes or no)-y-['S If yes, volume pumped 1500 gallonS Reason for pumping:—xyll-,OPt ��^ �� e -6 doh ✓,US� �I 1 �. 5�J� `�` '��'`�- TYPE 0f,*YSTEM U Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) NO (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1( t�ia��U W� N .k"©vltiC— Owner: V���� 0"'\j Date of Inspection: SEPTIC TANK: (locate on site plan) r/ n— Depth below grade.V Material of construction: _concrete _metal _FRP _other(explain) Dimensions: WX 5 X r-/ - `J UILM oN S Sludge depth: 0 r� Distance from top of sludge to bottom of outlet tee or baffle: ay Scum thickness:_ "7 If Distance from top of scum to top of outlet tee or baffle: er Distance from bottom of scum to bottom of outlet tee or baffle: 17 Comments: (recommendation for pumping, Condit• `of inlet ardoutlet t gssor files, depth of liquid le`v I in relation to outlet invgr), str ct raal integrity, evider ce of leakage, etc.) F !^ } l ACU C> `. to GREASE TRAP:"Y'%P (locate on site plan) Depth below grade: Material of construction: _concrete _,metal _FRP_other(explain) Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle: D iFtance from Notten) - .rill, 1- Will—' (H (SWT! lee or oaltle• Comments: (recommendation for pumping. condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C pp (n SYSTEM INFORMATION (continued) Property Address: i t0 R�J (XS, wQ"\ N • �VQ� Owner: c)Date of Inspection: IT-3n-9S TIGHT OR HOLDING TANK:N vV\e (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gal Ions Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:✓ (locate on site plan) Depth of liquid level above outlet invert: D Comments: �-�� • ( lam` p (note if level anq distribution is equal, etidence f solids carryover, e�lrlce of leaks a into or out of box, etc.) VLA V L�7 CCv COU_,vc- c d ter'. PUMP CHAMBER:WK,k0_--of6uil (locate on site plan) v Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ^ �SYSTEM INFORMATION (continued) Property Address: Owner: �C) Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):✓ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: _ leaching fields, number, dimensions: R— 3I X y`J f overflow cesspool, number: Comments: (notV con i ion of oil, signs of hydra (ic fail re, level of pon rtion of ve et tion etc.) w�a o cow IX CW [2 c_ ct�` u t e_ —� ► '� . CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: N-�ltNQ. (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (p C•�X'*%'S-A(ntA/, �¢X� Owner: 00\7 ttc S! t-, 5 Date of Inspection: V �— 36 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references la idmarks or benchmarks locate all wells within 100' � -�o S► = 235 ��e 56 91f � Je c�� A, s� � t16 3 a j p-(3ox -c�6r5% 0AX 4 5' DEPTH TO GROUNDWATER Depth to groundwater: C' feet - f <A� method of determination or approximation: O S �� J`�G V\ AA11, `ty<<��-t- y v � (revised 8/15/95) 9 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3?O�SS�ED /6`6 OL 19 O T * t� APPLICATION FOR SITE TESTING/INSPECTION SSACHUs���h Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Atlantic Engineering & LETTER OF TRANSMITTAL Survey Consultants, Inc. Land Surveyors- Civil Engineers -Planners 97 Tenney Street — Suite 5 Georgetown, MA 01833 (978)352-7870 — Fax(978)352-9940 Transmittal To: North Andover Board Of Health Job No: 9906-17 Date: 3/24/00 Ref: Lot 1 Brook Farm Attention: Susan Ford WE ARE SENDING YOU X Attached Under Separate Cover Reports Letter Original Plans Forms X Prints Specifications Copies Date Description 1 12/9/99 Septic As-Built THESE ARE TRANSMITTED as checked below: For your use Approved as submitted Resubmit copies for approval For Approval Approved as noted Submit X As Requested Returned for corrections Return corrected prints For Review and comment Other Initial C:\Win2000 Conespondence\Brook Fann\TR Lot 1 Brook Farm Septic Asbuilt-BORwpd FORM 4- SYSTEM PL11PL\G RECO i � y o AND Vj g$AN,D of HEALTH SEP 2 199 Commonwealth of Massachusetts , Massachusetts System Pumping Record -stem Owner vstem Location bDVASte- , k�4 Date of Pumping: � Quantit.- Pumped: ���gallons Cesspool: No es ❑ Septic Tank: No ❑ Yes <Al System Pumped by- rr License #: Contents transferred to: L6— Date Inspector i n , r a � 1304 L 76 r I �— 30'25-a ,T El EVAT'Ot,S 17210 H'Aj5E C' Tlf-r IAN 1 ST iP.LE IE.S.w S T OU—IET - j I 1) PO"� C-0 D F J'( )� r1 i T ►rc I) o 1 A LO T I 45 Y � X39 �Pt-/�N SIf,:G SURS_rRFCE SF\j,FW,,GF Z Di POSAL S`rSF-i,. , AS BUILT l-cAnof�,N LIST I CHPI'S T N V,.-M I CFKTt FY THATNE HT.O SYST�i,, MS fl��`��ILEC AS SI�O�.r.o Tl�s RAN SOV i ! IS NOT IN7NDm AS A s',: SYS RRANIY OF TFiE TEK. 'DATE 10-19-u 7 SCALF 1 " 40 PREPARED BY, y f.c1r. r SAssoc C C" Lill ubmmumwenlill orkisssbdtusetis . - �� " V,P-�M�ssztcituse is syslet�� I'u�n��it��1 Reourd Systetit Uhvllet Systettt LUcAllun 1I )ate of N111,14119' �� !� tlttnillily 1'UUlped: ���gtitttlh! Cesspool: No es Septic Ito& No System Polltped by: 'dt'eJs t �Kt' Ott did LiceU9b# Ccrnlettls ttanslettted Icy : Ofb11hlt LAwre"ta 081111 ltr ullklta Urate: • n Town of North AndoverNORTN 1 E OFFICE OF 3?0`,,go ,•o AV COMMUNITY DEVELOPMENT AND SERVICES ° . A 27 Charles Street :^9 North Andover, Massachusetts 01845 �OATfU �h WILLIAM J. SCOTT 9SSAC►w5Et Director (978)688-9531 Fax (978)688-9542 April 3, 2000 Mangano Development Comp. 36 Hillman Street, Unit 12 Tewksbury MA 01876 To whom it may concern, This letter is in regards to the Brook Farm Development, located at Christian Way, North Andover. Health Department personnel performed a septic system installation inspection at lot 3 on April 3, 2000. There was no problem with lot 3, however, concerns were raised upon observation of some of the other lots in the subdivision. Specifically,rubber tire tracks were found over the septic areas of lots 1 + 2. The exact locations of the track depressions in relation to the septic fields, distribution boxes and the septic tank were not known, however, this department is concerned for the integrity of the septic systems. At no time should a rubber tired vehicle of any kind be allowed on top of a septic system. Although the Health Department has already signed off on these properties we feel it is important to inform you of any potential problems we may observe. In speaking with the septic installer,Arthur Hutton, I recommended that, at minimum,the distribution boxes be uncovered to be sure no damage had occurred. I also volunteered to view the flow in these boxes, to confirm their findings if he so wished. In addition, these septic systems must be marked off so that this type of problem can not occur. It is obvious that many people around the job site do not understand or care what their actions could do to compromise the proper functioning of a septic system. Please note that this is only a recommendation. Feel free to contact the Health Department if you have any additional questions. 7Fo y, rd Health Inspector Cc: Lot 1+2 Homeowners Arthur Hutton, Installer BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Commonwealth of Massachusetts 0 Massachusetts r 2 5 System Pumping Record System Owner System Location II n Date of Pumping: Iv Quahtity Pumped: gallons Cesspool: NO/ Yes � Septic Tank: No Yes P p System Pumped by: Vctred6 L 45 jteo� License# Contents transferrred to : Greater Lawrence Sanitary district Date: Inspector: r TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: q-5-0 � SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED GALLONS CESSPOOL: NO YYES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE - EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Z4.9SN COMMENTS: CONTENTS TRANSFERRED TO: TOWN OF AvJwc SYSTEM PUMPING RECORD "' CL DATE: -� SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) 0ad l� C��'S�� DATE OF PUMPING: ' O QUANTITY PUMPED : U GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES V NATURE OF SERVICE: ROUTINE J EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACMULD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: Commonwealth of Massachusetts City/Town of SEP 4 8 2008 System Pumping Record TON N.,F ,' , . a Form 4 HI.F,. H -1 j . 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 Location: . forms on the computer, use only the tab key Address ^ to move your CEJ cursor-do not Gityrt.own State Zip Code use the return key. 2. System Owner: VQ Name Address(if different from location) City/Town State 4 C Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [ septic Tank ❑ Tight Tank ❑ Other(describe): EIN6---4. Effluent Tee Filter present? El Yes EI N If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: �J ,�/� 6. Syst m � an d . Bc�-� Name Vehicle License Number Company 7. Location ere contents wernposed: Sign a of Paur Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF A /-P,( SYSTEM PUMPI G RECORD OCT 19 2004 �� TOWN OF NORTH ANDOVER DATE: '� n(oC U HEALTH DEPARTMENT SYSTEM OWNER& ADDRESS S STEM LOCATION (example:left front of Douse) fl�- 6-A ll�e C6(- 11�j DATE OF PUMPING: vLa2oq QUANTITY PUMPED 0 C-) GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED To: G.L.S.D Lowell Waste Commonwealth of Massachusetts _-- City/Town of FSEP System Pumping Record 14 2007 Form 4 DEP has provided this form for use by local Boards of Health. Other forms may�be'usedI 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 Location: forms on the computer,use V only the tab key Address to move your l �/V` ��c::(" cursor-do not Cfty/Town State Zp Code use the return key 2. System Owner: Ibl Name ICI Address(if different from location) CitylTown State� . ��tZ�e Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes D_140 If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: s. systeg,Pj,.� r: P_�� Name Vehicle License Number Company 7. Location erenteq! aMsed: (C -07 Signature df H#ul Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts CitylTown of RECEIV 0 System Pumping Record Form 4 0CIT -5 2010 M DEP has provided this form for use by local Boards of He tf CQth@FW ® d, but the information must be,substantially the same as that provid rm, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health orother approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of h e, Right rear of eft rear of building. Right rear of building. ---------------- Address Cityrrown /vv State Zip Code 2. System Owner: Name Address(if different from location) CitylTown Stat' ��-- C� iD Code Telephone Number B. Pumping Record �? 1. Date of Pumping l v�:�epticTank umped: Date Gallons 3. Type of system: ❑ Cesspool(s) El Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi ion of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati re contents were disposed: G.L.SAHjl II a e Water Signature Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 11 � Commonwealth of Massachusetts FIHEALTH L.C�l�® City/Town of ' 2U zoll System Pumping Record F NORTH ANDOVER Form 4 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 1. System Location: Left front of house, right front of house, left side of house, right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. Cityrrown Stat Zip Code 2. System Owner: Name Address(if different from location) City/Town Stay � e Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of-S�y Woe 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. L ere contents were disposed: G.L.S.D I Waste a r Signature o H ler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts UAVER City/Town of System Pumping Record Form 4 M � 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 1. System Location: Left/Right front of house, Leftrear of hous Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address � City/Town �\ State Zip Code 2. System Owner. Name Address(if different from location) City/Town State ip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condiion f S stem: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: G.LS.R Lowell Waste Water Sign toe Haule6tS��_� Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1