HomeMy WebLinkAboutMiscellaneous - 1478 GREAT POND ROAD 4/30/2018 (2) 1478 GREAT POND KUAD Zoad
210/062.0-0028-0000.0 1
TOWN OF A AI(WW F
SYSTEM PUMPING RECORD
DATE:-��
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
�j e (example:left front of house)
V' vY
) 4?
` - Sid
l
DATE OF PUMPING: 5 ,23 - 03 QUANTITY PUMPED : &0 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:
i
� i
.aOR`+v
B O ARD OF HEALTH
120 MAIN STREET TEL. 682-641,83
NORTH ANDOVER, MASS. 01845 ExcL3
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 C'HR 15 . 354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
This form must be submitted to the Board of Health no less than
five ( 5) days prior to date of abandonment and be accompanied with
a cony of the sewer connection per-mit.
Name Phone
Address 7t- �•�.-� IW-z
Contractor hired for work:
Name n Phone
Address 3 �q Q
Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) removal ( ) sandfill ( ) crush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT' S USE ONLY
Inspecting Agent Date
Comments
rN
�J
N1146
C
APPLICATION FOR SEWER SERVICE CONNECTION
� Gy
North Andover, Mass. l/ 19
Application by the undersigned is hereby made to connect with the town sewer main in ���' ?'/ Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. f �� Street
or subdivision lot no.
Owner Address
Contractor Address
Applicant's Signature
C� S�I2✓�- poi[.!
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at <=� �� Street
subject to the rules and regulations of the Division of Public Works..
Division of P blit Works
7
B �
Y
Inspected by
Date
See back for rules and regulations
SEPTIC SYSTEM INSPECTION FORM
ADDRESS 14q p rD�`PA�'� q*d
DATE INSPECTED
PROPERLY FUNCTIONING? OY N
WEATHER CONDITIONS
COMMENTS :
WATER GZLALi i y T'ES tE'I--', ? ReSOLTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
i