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Home My WebLink AboutMiscellaneous - 121 GREAT POND ROAD 4/30/2018 121 GREAT POND ROAD ROAD J210/037.C-0018-0000.0 - - ACTION KING ENTERPRISES, INC. 26 Livingston Street Lowell, MA fl 852 COMMONWEALTH OF MASSACHUSETTS TOWN OF: NORTH ANDOVER SYSTEM PUMPING REPORT ACTION KING ENTERPRISES, INC REPORT FOR THE MONTH OF: MARCH 2006 CONTENTS TRANSFERRED CONDITION OF DATE NAME ADDRESS GAL TYPE TO SYSTEM 3/3/2006 ,CMTF REALTY TRUST 121 GREAT POND ROAD 1,000 SEPTIC LOWELL WWTP 34 - RECEIVED - __ ----- - _ _ -- -:- APR 0 6 _ TOWN OF NORTH ANDO�E:R- -- - - HEALTH DEPARTMENT - { -- -- HE-- L �jr� Commonwealth of Massachusetts City own of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 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: comma on the L 2 f computer,use on!y the tab key Ad a6 P to move your i ourfor•do rot use the return CliylTown Stag Tp Codd key, 2. System owner: �' r ' No7/6 Clkl-ltl �� o Addi rent from location)� a / S� Cly/Town State c� p r, Zip Code Telephone Number B. Pumping Record P � 1. Date of Pumpingpet—�- `� 2. Quantity Pumped: --�U Gallons 3. Type of system: ❑ Cesspool(s) I peptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yee, ❑ No if yes,was It cleaned? ❑ Yes ❑ No. b. Condition of System: 6. System Pumped By: Name ACTION-KING ENTERPRISES, INC, G 26 Livingston Street Veh ele Uoenae Number Company y-R-1.1. MA'018& 7. Location where contents were disposed: .... Sf9++ ro a r Date http:l/www.mass.gov/dep/waterlapprov slt6forms.htm#itispect t5form4l.doo-06103 r Syctom Pumping Record-Puge t of t / I A. Q Date.. 0 F.4. ..... .. .. Of NORTH 1ti o� p TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION M '1sfSSAC HUSEtI( This certifies that~. . . . . . . . . . . . . -� ' -r --*-� r has permission for gas installation . . . . . . . . . . . . . . . . . . . . . �t in the buildings o . . . . . . ^-'' -sr'"'Q at .. . . . . . . . . �"'worth Andover, Mass. Fee . . . . . Lic. No:� . . � �_ .�. .=PEl� ,1 . . . . . . . . . GAS INR Check# �/c� s 52L0 ` MASSACHUSEM UNIFORM APPLICATON FOR PERNIlT TO DO GAS FTFrING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS � � Building Locations v' " " ' f I&' /(` �%" _ Permit# Amount$ c:Srn o✓ Owner's Name A//�e, New Renovation Replacement ® Plans Submitted ❑ v� 0 C4 O U F v� C7 CY, F E" z z� a o F c a a Gw �, a w v a x C7 F � � F � W d p d O U o o Ir.7 z 3 a a ° a SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . .FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR y (Print or type) C1e c one: Certificate Installing Company Name /�/TV lsy / ✓ �� / M Corp. c, Address�,�,`' , / 1� ,441�'� El Business Teleptione <51-7 ie '-'7 �` ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �ly%ll vV �►/ /�Tr� INSURANCE COVERAGE Ch9ck one: I have a current liability Insurance policy or it's substantial equivalent. Ye No❑ If you have checked y_es,p se ind'cate the type coverage by checking the appropriate x. ❑ a Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are treandcatetothe best of my knowledge and that all plumbing work and installations p rmed unde Permit Issued for this apbe in compliance with all pertinent provisions of the Massachusetts S G s Code hapter 142 e e gnre of Licensed Plumber Or Gas fitter By: ❑ Plumber (� Title Gas❑ Gas Fitter ice se Number aster APPROVED(OFFICE USE ONLY) ❑ Journeyman t COMMONWEALTH OF MASSACHUSETTS TOWN OF: NORTH ANDOVER SYSTEM PUMPING REPORT ACTION KING ENTERPRISES, INC REPORT FOR THE MONTH OF JUNE 2005 CONTENTS TRANSFERRED CONDITION OF DATE NAME ADDRESS GAL TYPE TO SYSTEM 6/21/2005 CMTF REALTY 121 GREAT POND RD 1000 SEPTIC LOWELL WWTP 6/28/2005 CMTF REALTY 121 GREAT POND RD 100 SEPTIC LOWELL WWTP RECEIVED JUL - 8 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT PETER L. HORNBECK 121 GREAT POND ROAD NORTH ANDOVER, MASSACHUSETTS 18 November 1993 Dr. Francis P. MacMillan, Chairman North Andover Board of Health 120 Main Street North Andover, MA 01845 CERTIFIED MAIL - RETURN RECEIPT REQUESTED Dear Dr. MacMillan: In accordance with the Board of Health requirements I am pleased to indicate that I have had my septic tank pumped on September 29, 1993. Be so kind as to file this letter in your records along with the copy of my invoice and my cancelled check for the work done. Thank you. I Peter L. Hornbeck PLH/mcc Enc: Bateson Enterprises invoice for $135.00 P.L. Hornbeck (front and back) cancelled check #1625 I was told by Carol Tawelski that there are no forms and to send in this documentation to meet the requirement. STATEMENT Tel. (508) 475-4786 Bateson Enterprises Inc. 111 Argilla Road • Andover, Mass. 01810 Sept. 3019 93 r � Hr . Peter Hornbeck 121 Great Pond Road North Andover , Ma. 01845 L J To insure proper credit please return this stub with your remittance. AMOUNT$ 135.00 DATE DESCRIPTION AMOUNT 9/29/93 Pumped Septic Tank $135.00 Bateson Enterprises, Inc. -Andover, MA 01810 I I I I y� y i PETER LOUIS HORNBECK 121 GREAT POND RD 1625 NORTH ANDOVER, MA 01W PAY TO THE � � — 19 53-59/113 2 ORDER OF • I."'�`.'c�71 v�I � jJ �.. l -C /"'t7� DOLLARS ' CAMBRIDGE, MASS. . j MEMO '` / -elG 300 5 9 5i: 1r 1„ 0 2 700et1611 O L 16 25 t L v, . �:. X •�Iir, '931 C 1 1 u o ,r, LUN �� ..� - •-' i n ULU Lu Ll C Lu ED c C # GAB BUSINESS SERVICES,INC. CATASTROPHE OFFICE 85 Central Street, Ste 201 Waltham, MA 02154 TEL: 617-891-0671 FAB: 617-893-9952 To: Building Commissioner/Inspector of Buildings Board of Health/Board of Selectmen NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1, 000. 00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section #B 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 the GAB file number. Insured: HORNBECK_F- , PETER Property Address: ,-1`2-1 GREAT POND RD�� ` 'NO-ANDOVER-,--MA- 01845 Policy No: HP1005588 Date of Loss: 08-19-91 GAB File No: 10860 - 01532 Frank Edwards Supervisor On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Signature and date ACnONAING INTflPAJ594, 1NC,. 26 Iivimidoh Street MA MONWEALTH OF MASSACHUSETTS TOWN OF: NORTH ANDOVER SYSTEM PUMPING REPORT i ACTION KING ENTERPRISES, INC REPORT FOR THE MONTH OF: MARCH 2005 CONTENTS TRANSFERRE CONDITION OF DATE NAME ADDRESS GAL TYPE TO SYSTEM 3/18/2005 JOE FISH 1120 OSGOOD STREET 2000 GREASE CORRENCO t 35 3/22/2005 DEMOULAS 121 GREAT POND ROAD 500 SEPTIC LOWELL WWTP 35 RECEIVED APR - 8 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT