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HomeMy WebLinkAboutMiscellaneous - 1785 SALEM STREET 4/30/2018 (2)N -o T Commonwealth of Massachusetts City/Town of No Andover ° 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms 1 on the computer, use only the tab key to move your cursor - do not use the return System Location: I r7 25 32 le Ill 7�+i Address No Andover Ma key. City/Town 2. System Owner: Name Address (if different from location) City/Town State ._ Zip Code S � 7 ' 4V 14u State Zip Code Telephone Number B. Pumping Record lollo A� In 1. Date of Pumping ate 2. Quantity Pumped:--�-u`-'� Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 00W 6. System Pumped By: 11 Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewa re -treatment Plant, 20 So. Mill Bradford, Ma 01835 Signa Date Signature Receiving Facility ate t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab Key to move your cursor - do not use the return key. VQ �enun Commonwealth of Massachusetts RECEIVED City/Town of North Andover System Pumping Record NOV 1 U E011 Form 4 TOWN OF NORTH ANDZut DEP has provided this form for use by local Boards of Health. H WfiL D,tE�pgU the information must be substantially the same as that provided here. Before u'siinngYtthis 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information 1. System Location: �!+r _ _.__. ..------- Address F7 IQ North Anover Ma 01810 City/Town 2. System Owner: �. Name State Zip Code Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping ate i/ 2. Quantity Pumped: GOO aTFons 3. Type of system: ❑ Cesspool(s) 4 Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes X1 No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: aGo 4A, t5form4.doc• 03/06 6. to Pu pe ' e Stewart's Septic Service Company Vehicle License Number 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Date I I1 ^ Date [) System Pumping Record • Page 1 of 1 I - ; :fi MASSACHUSETTS DEP hc# P(QyldQ(l W.; (QfM f)r L60 IC), 0 fr. I (I , a 1 8 0 a f c 0.(j (o 00 10"1 E30atc Ot rloai(n or c(tjor Faclllty Inforr��c!on- L Cq/T Nwnj 901MI IIQM brAuQn) 97f -6t pumping Cato Of Pum, in L pUC TanA a. E MOM Too F11(o( p Yo yes, n85 1: Voanao? Yes .... ....... .......... ........... SY Pvm UC4 nit N!,;� 0 1 /71, 7 L V4 - --------- Important: When filling out forms on the . computer, use ,y only the tab key to move your cursor - do not use the return key. l�I � 'Commonwealth of Massac City/Town of NORTH ANDD System Pumping Record ,.,Form 4 t etttS �rai•�-=• tR,MASSACUS ETTS I 0 C T 1 2 2006 TOWN OF NORTH ANDOVER DEP has provided this form for use b local Boards of Health. The HEALTH DE"'ARTfr,ENT Y �ystem`Pumping Record mu. be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Address Clty/Town--- tate----- Zip Code 2. System Owner: Name Addres.3 (if different from location) City/Town - - ------ State —_------- Zip Code _ 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 [ - If yes, was it cleaned? ❑ Yes, ondition of System: ` 6. Sy em Pumped By: ame Vehicle License Number 6t a Company -- 7. Location where contents were disposed: r -- _..._..._.._.._.. --.._ ....-`- 1L -- - --_-_- .....-...-..-..- . Aw atureofau p/wSi HDate hnp://www.masg;gov/deater/ ..-- -_ - provals/t5forms.htm#inspect t5form4.doa 06/03 System Pumping Record - Page i of Ir N A N UA 11 �Y$78m j PUMPIN( 1� / PR c 0 L // - ©bYNBR It ADDRESS DATE OF PUMpINQ: Z�2 QUA NTITY PUMPCC, I- LziSPWL: NC) y fix 14A rUK6 0,w >K 1% Qt,z, eA YA nuN3. 0000 mt-iorrio'N U1 hY, KXAVY OV.BA38 N PLAt-:L KOCT3 - - L &.A.,C Hpl exc"Wo SOLlos FLOODLID KLNbA0. SOL rD CA" Yo YEA y .4v m t;x&.Zjo j, SEP — 7 2005 TOWN OF NORTH ANDOVER HEALTH DEPART,"ViENT Tb`WN O.F NORTH-ArOOVFR SYSTEM PUMPING RECou �1 D'I'EM OWNER & ADDRESS w. 1775 5� !UO SYSTEM LOCATION (MmPle: left front of house) UATC OF PVMPINC: ,.5" p3 QUANTITY PUMPCD jDvy Ll u.�, "'1:'»I'UUL:'NO �YES SEPTIC' TANK: NO YES NATURE OF SERYICE: ROUTINE ' EMERCENCY _ 111:>rRYnTIoNS: �� .. COOD CONDITION. FULL TO COYER HP-.AYY CREASE. .8AFFI,2S IN P'LACE' ROOTS LEACHFICLD RUNUAC'K... CXCESSI•YE SOLIDS FLOODED SOLIpS CAR'RYOYER' - jp�HER (EXPLA.IN) >1'>'I'LM PUMPCD 0Y:: 61,:�, .:: Tow DATE- �► (,/l�� o�(�I SYSTEM OWNER & ADDRESS S t.,oSal tizl 1795 AVO • Q/1/,�oVe�, /Y'iq. y A.' A/ . PFNOUH ANDOVER M PU&I >ING RECORD qp 1111 - 2 r r++'�"": r i ZM LO CA•11ON ` �*DA/ f DATE OF PUMPIN4 �. � QUANTITY PUMPED /001) CESSPOOL NO _ Y£S, SEPTIC TANK NO YES NATURE OF SERVICE;,,RQ(T NE ' EMERGENCY OBSERVATIONS: GOOD CONDITION ' ' . FULL TO COVER 4AVY GREASE �, : BAFFLES IN LACE ROOTS �LEACHFIELD RUNBACK EXCESSIVE SOLIDS T_'FLOODED SOLID CARRYOVER OTILR EXPLAIN SYSTEM PUMPED BY • �� 7 77L. COMMENTS; CONTENTS TRANSFERRED 4 r1i TOWN OF NORTH'ANDOVER SYSTEM P'UMPINC R. CORD 1) VIA.:: 5c 99 r �1 D'I'EM OWNER & ADDRESS, SYSTEM LOCATION (example; left front of house) Nd Abvdvw- UATC OF PUMPINC. QUANTITY PUMPCD IO66 C; L*Lt),,1 ;.�:a.Si'UUL; NO SL YES SEPTIC TANK: NO YES____ MATURE OF SERVICE; ROUTINE _ EMERGENCY _ tfli.- rFRY;\TIONS: COOD CONDITION, FULL TO COYC- k .� HFAYY CREASE UAFFLES IN I'LACI' ROOTS LEACHFIELD RUNOACK...i,,/ CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER :P�HF,R (SXPLA.IN) ^^ FUM pED �3Y: CUM Yl r,. NTS; TRANSFEIMED TO, TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: Sl STEM OWNER & ADDRESS 17, SYSTEM LOCATION (example: left front of house) 1-1 f gori DATE OF PUMPING: 6, l$ -P ZZ. QUANTITY PUMPED dt7D GALLONS CESSf OOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: CO'1INIENTS: CONTENTS TRANSFERRED T0: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) cY�/VJ/1JJr VV. JV JV VJ�JVV11 JI CNJHr.1/HIY1JUVG�. 1'HVG U�4 • II 47 � sMvrcZ r MNX'00, MR 01835 978-372-7471 "Mm cp fon f— amas pm mm ar No 4� I500 ��� << waste( Loi Mob ? 0 R5 -�YQ /am yj /3 q Q /ock tao Qjn st A noon,.,- . C. rns- 1 Le- 47 � sMvrcZ r MNX'00, MR 01835 978-372-7471 "Mm cp fon f— amas pm mm ar No 4� I500 ��� << waste( Loi Mob ? 0 R5 -�YQ /am yj /3 q Q /ock TO: FROM: his" 311a& -R ' -p NORTH ANDOVER, MASS BOARD OF HEALTH DESIGN ENGINEER 11144111 .3 ig '7? Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at LU% -13 57/9/1:/V •5 77- " North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 ro�'�w -PLT of 9 eg. 'TFR SA Mi" ROOLWnitarian LT Lvi& b c //z 1 6 No, I Na, RIFA ,S JAI G 671317, ./ c, 7- -1'3 ,0" OF ,1, JOSEPH C� 8A P, 70 "54 Cl) C-1 '70 o NORTH B.NDOVM. BOARD OF HEALTH INSTALLA TON dfE6K LIST APPROVED DI SAPPROVED Date: Date: �z> 7$ Reason: 1 A Built Submitted Check: Lot location, dimensions. of system, location in regard to percolation tests, depth of system, Crater table EXCAVATION OK 2.�A�ce to Wetland Areas, Drains, Street & House, Drainage Easement and Wells. 3. Wate ine Location 4. No/(C Pipe 50, Septic Tank - Tees, Cement -Pipe to Tank -Joints on both side of Tank. 6. Distri ti - bu on Box No crasin box or cover, 1 lines flotr ecrually from ox. 7. Leach elds - Dimensions, Stone Depths, Capped ends, Clean double -washed stone 8. Lesch Pits - Dimensions, Depth of Stone, Splash pads tees, Cement -pipe to tank - joints on both sides of tank, Clean double -washed stone No Garbage Disposals 10. F,fial Grading icading of sub -surface system [ L �T 43 17 f2 U � rEXP 4U -A Y. 1 1 2.5 $fla tp J ?= ro io I Z5' J . j. ate►, o� _ gz- x99 - �A �141L a SIM• :►flo.o Joseph i. barbagallo, r.s. 1 westward circle no. readincm_msaQQ_ _� Q ouTLr-T ;3Q i 41 Imi l I o Ul � S lu�r F .o OUTLET i7.6i � 'cn INLr,T ` 97.4-L L ouTLr--T Pin -v IT gi 0 do cIt Ii I`aO �f 1 �. t p` 0T 0 � i 41 Imi l I o Ul � S k - r� t2C' r a t.. • �� , is 7 J -.. y'f - • '� 1Py.F si i 4 _ b•Ac 1,g Hy i nit 0. ,I��T+fit it y� rM 1f•1r �^�a �1 a ,1 t�' f.4. rr i TOWN OF Np12TH ANDA SYSTEM P VER ' UMPWG RECORD �"�`��4�i7�:�d ` �pIM�. S+i A+ "� r�`,ti.. j� 1t^ ���. =+1,) r w.iX. •,^ ���, , � � ' 77r =r .• l 1 SXSTEM OWNS d�fc ADDRESS + { SYSTEM LpCATION :, , ` w• ', �'� ?-t� . + tpple: t front Of house) #, a t^2;! �, i w%n, tiPi x r 4, r',,. ; r1 = �.: :,,..� • , �7 l�14 1 T-1211 IRMA F, =�.f art >r + . t ,�` .. � ;�4}irJ+., .,6Y. ,• .. - ... , r r, QUANTITY PUMPED GALL ---lLONS YES TANK SEPTIC • NO � YES Iy ;fiK OF.SERVICE. ROITTINE ♦ 2 b EMERGENCY ;♦ 4s� 9.'� i1r o � :q r M1 d"e�., r x i ��, J I "^� � P�^+R, Go'OD GOND HEAVY GREASE, CONDITION' :FULL TO COVER ' .. �,, i `.ROOTS -----► B AFFLES IN PLACE y-=° iu 5„{:CESSIVE SOLIDS FLOOD�EDii+/�..I••YY i`VNit1ACyK —_ E; SOLIDS CARRYOVER —�.._ OTHER (EXPLAIN) . 4 �>♦'i,y� .•1 - ,j � � fI' • ' 4 4 S 4^ r i.'I .1 '_ � - _ - av-low,-" _; '�, �, ire > ;.� ;� � w i , � • ✓Vr^!OF1rnR��P, C lu 7".. 4►� � �=oaf + ern"?� r rr y::= � i ,:� r � �•� � i .r, uS J - 1 - �rA7�.y7,i1i'14�+C}yi;��'.•'��� +��'r7��r�k�lr;m'y�1i•��,i7 a'f 'ti. ��a�{��y� h,a' � i VIM • 1�_ _ setts it tQ nt.Q -NORTHANDOVER MASSACHUSETT t`r fV ,�Syte P g Reco ,� Sr m umpin r 'Fo�'1' i C'. G S -4,rf Jf7, +t (: .. �'I.�FIIVI,,�+yirjet+'. .. r,^ yJ: to- .a`��trl l ✓F,. r = .i DEP,.has'provtded this form for use by local Boards of Health. Th SystiPu ib ecord must be submitted to the local'Board of Health or other approving auth rity TOWN OF NORTH A1,4UQyER A: Facility Information - trnportant. .,-, ,When• filung out 1 System Location �J w fo mo: on the ` /T(�S �� CS %� Computer, use,; :: to m the Yourtab. _iy Address y to move your._; cursor • do not use the Tatum City/Town State • • Zip Code . Bey 2 System owner Name Address (if different from location) City/Town State . g Zip Code Telephone Number umping RecXlr ord: N 7.. Date of Pumping nate 2. Quantity Pumped: Gallons 3 Type of system ❑ Cesspooi(s) I3' -septic Tank • _ ❑Tight Tank [] other (describe) 41;`, Effluent Tee Filter present?. ❑ Yes Q'No If yes, was it cleaned? ❑ Yes ❑ No ,,r t lt: ;. , c • Conditlon of Systgm 6 Sy em Pumped By Nama I . ,Vehicle Ucen$e Number J/gut• * r ...Company , 1 ' ' li I o t , / • 7 Location where contents Were disposed: J 4 , 11 Date http.//www mass.gov/dept afer/approv4ls/t5forms,htm#inspect t5form4 doc 06/03 System Pumping Record • Page 1 of 1 �iiI141.Y�! IMF+I.• f .... . . Vt:Y,hll ptQYld-d )hI /orrn I,)r t.lo �.) ;o ul goa TOWN OF NORTH AND( 0o I o to thr Io ,I ALTHDEPARTME C BCir(: (•! nOJI{n OrClltor IA?r.Orin� �•ypr_r a' Facility Infora) �Uon Ll . I: ' Ic+l. r i �',• ' '� 'Jit .v „`r 1. • .. ! "-------- v ,�Gi1 :.1,.1:'t•1J1'I•'' I.,` u..y�..:y.l' � 8 pr . ' •'• .�'''� ' •r+14"i,,.li v'S' y�.t4 X11/•. " ��1. •, +'•�,'(�:,'i1,. V'll , 'i,t .51,1 ' •':''J.4dIHt (114 , ulnl Ip-n'buVon) v����.. rllr7n0�1 n.moll �� Tympinq-�apord (. Oato of Pvm`DjA9,1; �', 'TYDe 41,+yi►em;`.;• �1. Coss�ool(s) � ��'---- •'' '� �Dl•C ian, scrttiej en.J1Tf0FII(`Yo) �p,aonr? [' ���`�; Leo It y97. f,'81 I; C'OanOJi (1 T S .. •'4�, ..19 ,r%1'. ,li�'L/� Lw'�n I/I�r'l:'' ��� ' '•�'�, ;•i'�61'1',y�J!I''JI,�'/''1.4'(I!t''Jt4:�'�YPPP/�,•':; ' t• y j pvmped,8y:' ' :,.�"t„•1�('j�; •�' x•11 n,l •,►/� ' r' i� r 1 y li i t� V/ %l X1y9•,/ /y�4� n— � '�.I.4. ,1/�,t�f �'�;i,�r «yli� ll�ll%► �Y�%./ � ���J'��'`'.I�'' ! ..I 1, .l,p ' ' k 1. c• who=' I 151•x;11•. , er95�oplenla,�t3ro - , .. •.. ,; '�;'. ' 1 I11I; :�.I' ' • r:'• 1” 11 ��1 I 9/HIV Y' rma.poY/dop�weioile9D�ore/ailb/ormI �tl s,n:,n; n�9bcl -C\- Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 Important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. DEC 1 N TOWN OF NORTH ANDOVER HEALTH 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information 1. System Location: Address _ North Andover ma 01886 Citylrown State Zip Code 2. System Owner. n Name Address (if different from location) City/Town State Telephone Number B. Pumping Record 1.q.tD 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped 0 1 KL Lnn VU Name Stewart Septic Service Company Zip Code /t00 C-�- Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No Q Vehicle License Number 7. Zbon wher contents were disposed: rts Pre tment Plant 20 o. Mill St, Bradford Ma 01835 l /Yk n t re of Hauler Date Signature of Receiving Facility Date t5form4.doa 03/06 System Pumping Record • Page 1 of 1 November North Andover Board of Health 1600 Osgood Street North Andover, MA 01886 Haulers Permit # BHP -2010-0326 BHP -2010-0327 Date Name & Address c 1.1/oi/10 Robinson 89 bruin hill road c11/o1/10 Tschirhart 283 Cambell road L11/o1/10,Lavery 259 Campell road (11/01/10 fhcoluien 57 South cross street {1-1/04/10;Declerca 55 Farnum street C11/04/10 L-ennhoff 657 forest street ,�1/04/10 Norman 79 Fuller road C1 1/05/10, Saleeme 511 Winter street 11/o9/10 Evans 175 Olympic lane 11/09/10 Sweetra 1785 Salem street 11/10/10 Wallance 54 Lacy road 11/11/10 Sullivan 140 Bridges lane 11/11/10 Dellorfano 466 Winter street 11/15/10 Lacey 16 Ogunquit road 11/15/10 Toomey 44 Oak drive 11/15/10 Manchini 203 Grandville lane 11/16/10 Mcgrath 247 Bridges lane 11/18/10 Grover 35 Marian Dr 11/18/10 Lucis 39 Deer meadow Rd 11/18/10 Hanly 71 Olympic Lane 11/18/10 Dido 549 Winter st 11/22/10 Dimilla 73 Farnum St 11/22/10 Lind 575 Winter St 11/22/10 Jillison 757 Forest St 11/23/10 Tanglis 149 Summer St 11/24/10 Maclary 174 Ingalls street 11/24/10 Fleishman 981 Forest street 11/24/10 Kelly 17 Crossbow lane 11/29/10 Maglio 166 Granville Lane 11/29/10 O'brien 7 Carlton Ln 11/29/10 Gaul 1435 Salem St 2010 AEC 1 a 2010 TOWN OF NORTH ANDOVER And ov&''"LffM'Service 58 South Kimball Street Bradford, Ma. 01835 Installers Permit # BHP -2010-0422 GALLON COMMENTS 1500 good 1500 good 1500 Good, 1500 LFRB 1000 Good 1500 Riding high 1500 Good 1000 good 1500 Heavy 1000 Good 1000 Good 1500 Good 1000 Good 1500 Heavy 1000 Good 1500 LFRB 1500 Good 1000 good 1500 good 1500 good 1500 good 1000 good 1500 good 1500 good 1500 X Solids 1000 Good 1000 Good 1500 Good 1000 LFRB, RH, X solids 1000 good 1000 good