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HomeMy WebLinkAboutMiscellaneous - 150 BRADFORD STREET 4/30/2018 (2) ,� C7' _� �� �.; Commonwealth of Massachusetts City/Town of 2014 System Pumping-Record Form 4 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 Locatio . Rig ont:h�q , Left/Right rear of house, Left/right side of house, LeftRight side of buil iLeft/Rig tnt 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�G^ „ Zip Code ; Telephone Number B. Pumping Record rU- � r 5° C 1. Date of Pumping pate 2. Quantity Pumped: Gallon 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Er No If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition of System: 6. System Pumped By.- Nell y:Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: G S. Lowell Waste Water Sig Hauler()'— Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts Zer D City/Town of System Pumping Record Form 4 DOVER MENT DEP has provided this form for use by local Boards of Health. Oused, 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 Locatio : Le lgh ont of house Left/Right rear of house, Left/right side of house, Left/ Right side of bui lnft/Right front of building, Left/Right rear of building, Under deck Address Cityrrown State Zip Code 2. System Owner. Name Address(if different from location) Citylrown Stat Z' ode Telephone Number i 1 B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons r 3. Type of system: ❑ Cesspool(s) Septic Tank El Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Leo If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition Qf Sy m: �vv 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location Mkere contents were disposed: L 'S.Q Lowell Waste Water Signitufe qt Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusettsca ► n City/Town of j System Pumping Record NOV 12 2012 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be use , 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:�ight ho of , Left/Right rear of house, 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 Stater gipC� Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes o If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of ystem: c) 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: 7-08-p Lowell Waste Water �- SignAtufe ct Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: �o� SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) r-) t— 6�— ko A DATE OF PUMPING:_Ld c 0,9-,QUANTITY PUMPED ( OC GALLONS CESSPOOL: NO YES SEP IC 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: COMMENTS: CONTENTS TRANSFERRED TO: � � i Commonwealth of Massachusetts LRE City/Town of w� System Pumping Record 2007 Form 4 AN 77VER c ��DEP has provided this form for use by local Boards of Health. Other ; t information must be substantially the same as that provided here. Before using this for;,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. SyStm LOCatI Q /" forms on the computer, use only the tab key Address to move your ` cursor-do not City/Town State Zip Code use the return key. 2 System Owner: VQ Name Address(if different from location) Cityffown State/')5^`(`„ '?p CSjde Tele`ep-h//onne,NNuumbeerr B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 2-60If yes,was it cleaned? ❑ Yes ❑ No 5. ConditioSystern:� � 46 6. Syste P Name ehicle License Numb 7 Company 7. Location re contents were osed: Sign u ler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I h reby make=cation for a permit for a sewage disposal installation at I will install this system in ac- cordance with all the laUs of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 29o. I will install a con- crete septic tank of le-r— in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE S - -)- 7 - c� r / Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE -�- - 7 - 7,� Sign tur o ealth Agent I have inspected the uncovered system indicated above and find everything done as described. DATE �� �- 17,o 4W Signature nspecting Offic Percolation Test jcl Garbage Grinder r 1 BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. ---- if 1. NAME cl T� DATE 2. ADDRESS j LOT NO. TEL. -Q SGP 3. NO. OF BEDROOMSy DEN YES � NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. IF t BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL DATE NAME OF APPLICANT C.-'0A---a8.A LOCATION Z- ddress of lot no, BUILDING: Dwelling K Other SYSTEM: New Repair GENERAL DESCRIPTION OF LAND �• SUBSOIL: Clay 'X Aavel Sand PERCOLATION TEST I Q minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK�-p- gallon capacity. LEACH FIELD �Z-0`0 lineal feet of drain pipe. William J. Dri c il, Engineer Board of Health �-7 � APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER MASS. 5J A�I hereby ake a ilic§tion for a permit for a sewage disposal installation at /-111 �' -u . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1/ until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE �� A ---- � O Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Y 3, /l'7 d Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as describe DATE r o 2 3171 w Signature of I specting Officer Percolation Test ��� Garbage Grinder � 4 1 + BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. l ago G kL "A 1 1. NAME J �- ,) T r 6llf=A I Ty ����C/✓ IT _ DATE 2. ADDRESS �1 U 1� S LOT NO. TEL. 3. NO. OF BEDROOMS J DEN YES NO 4. GARBAGE GRINDER YES NO C.-r 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. i n BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE 54-1/70 NAME OF APPLICANT Ernest E. Parent LOCATION Lot #12 Bradford St. Address of lot no, BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay___I_ Gravel Sand PERCOLATION TEST 10 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. Wi liam J. Dris l 'Engineer- -Board of Health TOWN OF CEIVED SYSTEM PUMPING RECO NOV 18 2005 —1 �� TOWN OF NORTH ANDOVEP I DATE: HEALTH DEPARTMENT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of CL+� DATE OF PUMPING: K-1L-(-6< QIJANTrrYPUMPED : 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 R � ®r� , Massachusetts NOV - 2 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT System Pumping Record System Owner System Location t � © Date of Pumping: '�— Quantity Pumped: i C7 gallons t7 ' d Cesspool: No [ Yes [] Septic Tank: No [] Yes [ System Pumped by: e4a"a License# Contents transferred to: Greater Lawrence Sanitary District Date: �O ��� T Inspector: Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record OCT 2 4 2006 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 fining out 1. System Location V� forms the computer.use only the tab key Address to move your �? Alcursor-do not i use theretum City/Town State Zip Code .key. 2. System Owner.- Name til Address(if different from location) CityfTownSta"'. ip Codes... Telephone Number B. Pumping Record Date.of Pumping Date 2. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank- ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition SYst�rrt: 6. System P pe Name Vehicle License Number Company -- 7. Loca"0 here contents er posed:. Signal e o a er Date http://www.mass.gov/dep/water/approvalt/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 Address 251� &&)fid?6 Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes. action Document/ document/ Num. Action De artment Board of Appeals - Board of Health - Planning Board - Conservation Commission - Buiiding Department r� G. C47z�!Massachusett Massachusetts v ' s System Pumping Record System Owner System Location U sctoa graAF(r".)c 4 S4- Date of Pumping: �-� j�--� Quantity Pumped: jCenc—,gallons Cesspool: No (�� Yes L:J Septic Tank: No Ll Yes +-t—� System Pumped by: Fctreo4rt License# Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector I I TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: L4 ,10r3u� SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED j GALLONS CESSPOOL: NO ----Y--ES 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: 3 200 COMMENTS: NOR CONTENTS TRANSFERRED TO: �' FOILNI 4 • SYSTEM 1'U.NIIIL`G RECORD Commonwealth of Alassachusetts Massacllllsetts TOWN OFNORrHAN�p BOARD OF HEALTH 27 Stent Pun lin Record sten-1-MM er stem ocetron Sour Pumping Z� ^G Quantity i'umped: OOL) Date of Puml E t t l Cesspool: ',o , Yes ❑ Sentir TanL-- N'- Yes 4�- �-S� License �: J S��stent Pumped b.': � LS Q Contents transferred to: Date Inspector t-fill►►gollwo►il�t u�/�� a�aclu,aeiis R �ysl�ni tlw►w�i;��-------_._._______._ -sysiei�i.��cAilur� _.___ i�nla uf i"ru►ri�iutl� '���� l '-�� —�� tluai�tl►y I�ut��p�d: ��� gniiatts No �-1� �'ea ( I Septic: "Ralik: No 'e9 � �yslt+tn Ir�i►tr�r�41 uy; ��Ce�a� �� �ti4ed Llo►egsts # _ arnita►is itnt►ai�urc�l W : r..:,.::r Lwrrinii�b n1�ry�rl����� n IC-N Commonwealth of Massachusetts City/Town of RECEI System Pumping Record Form 4 N O V 10 2009 M DEP has provided this form for use by local Boards of Health. Other fo m)p0*as% I, r*eR information must be,substantially the same as that provided here. Befo e uWkWERHETAM i1h your local Board of Health tq determine the form they use. The System Pumping Record must be submitted to the local Board of Health ol«otLLe%approving authority. A. Facility Information 1. System Location: Left side of house, Right side of hou e, Left front of house Right front of house, Left rear of house, Right rear of house. Left rear of building. Ig rear o wilding. Address t City/Town `P.J1 r State Zip Code 2. System Owner: Name Address(if different from location) Cityrrown State� SG-IN l_ To Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) p is Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes to If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loca ' contents were disposed: G.L.S.D Lowell Waste Water v-31 Signature of Hauler Date t5form4.doc•06103 System Pumping Record.Page 1 of 1 i Commonwealth of MassachusettsCEIVE City/Town of r a System Pumping Record FT Form 4 TOWN( NAR`I'B ANDOVER tifrAt�N 02PARTIVIS DEP has provided this form for use by local Boards of Health. Other orms 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 housed ight 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. Citylrown State Zip Code 2. System Owner: kASGL Name So &aA -4k Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record C 1. Date of Pumping t r J 2. Quantity Pumped: 1 C3 o Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ES/No If es, was it cleaned? ❑ Yes No Y ❑ 5. Condition of System: n ' 0'1 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number _Bateson Enterprises Inc. Company 7. Location where contents were disposed: L.S.D. Lowell Waste Water Signature of Hauler' Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1