HomeMy WebLinkAboutMiscellaneous - 2135 TURNPIKE STREET 4/30/2018 (2)OO
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-C-\ Commonwealth of Massachusetts
W City/Town of NORTH ANDOVER
W° 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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
MAY Z is i a
Important: When
filling out forms 1. System Location: TOWN OF NORTH ANDOVER
on the computer, HEALTH DEPARTMENT
use only the tab 2135 TURNPIKE STREET
key to move your
Address
cursor - do not
NORTH ANDOVER
use the return
Citylrown
key.
2. System Owner:
JIM CHLEAPAS
�emm
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping Date
3. Component: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank
5/15/15
MA
State
State
Telephone Number
2. Quantity Pumped:
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
6. System Pumped By:
JAMES H CURRIER II
Name
X SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD
Sign Gat re of Hauler
01845
Zip Code
1500
Gallons
❑ Grease Trap
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
5/15/15
Date
Signature of Receiving Facility (or attach facility receipt) Date
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
r NORT[1 ANDOVER FIRS -DEPARTMENT
CENTRAL FIRE HEADQUARTERS
7"1
124 Main Street
North Andover, Mass. 01845
WILLIAM V. DOLAN
Chief of Department
CHIEF DOLAN
N. ANDOVER FIRE DEPT
SUBJECT:
HAZARDOUS MATERIALS INVESTIGATION.
09/14/90
Tel. (508) 686-3812
FF T ., VERNILE
NAFD HAZ MAT
09/17/90
ON THE MORNING OF SEPT. 14,1990 NAFD NOTIFIED AND
RESPONDED TO REPORT OF POSSIBLE HAZARDOUS WASTE ON PROPERTY
ABUTTING 2,135 TURNPIKE ST. N. ANDOVER,_MA.`
JOHN WARFORD; REPRESENTING FEDERAL.REALITY TRUST OF
65 FEDERAL ST. WILLMINGTON, MA,INVESTIGATED AN ODOR FROM'NEW
CONSTRUCTION SITE ADJACENT TO 2135 TURNPIKE ST. CONSTRUCTION
SITE OWNED BY ED PLUGIS (TEL. 508 667 9707). MR. WARFORD
STATED HE FOUND SEVERAL CONTAINERS AND NOTIFIED NAFD.
ENGINE 2 AND RESCUE RESPONDED. LT. TAMAGNINE OF E2 FELT
THAT SOME OF THE CONTAINERS MIGHT BE HAZARDOUS AND CALLED
FOR HAZ MAT PERSONNEL. DEP. MC CARTHY AND FF VERNILE RESPONDED.
AREA SURVEYED. FOUND UNLOCKED DEISEL TANK (75 GAL CAP) WITH
HOSE ON GROUND AND A SPILL OF ABOUT 10 GAL. ALSO FOUND ONE
.5 GAL. CONTAINER MARKED CAUSTIC SODA WITH APPROXIMATELY ONE
GAL. OF PRODUCT REMAINING. TEST FOR CORROSIVES DONE WITH
PH PAPER. TEST REGISTERED PH OF 14 (HIGHLY CAUSTIC). ALSO
FOUND ON SCENE WERE ASSORTED AEROS(IL CANS (RAID, HAIRSPRAY,
HOUSEHOLD CLEANERS;AND EMPTY QT. SIZE OIL_CONTAINERS).
HOUSE UNDER CONSTRUCTION FOUND TO BE OPEN. DEP. MC CARTHY
INSPECTED AND FOUND ONE 40 LB. PROPANE TANK STORED INSIDE
HOUSE.
BLDG. INSPECTOR (R. NICETTA) AS ALSO ON SCENE
D.E.P. NOTIFIED AS WELL AS N.A. BOARD OF HEALTH
OWNER HAS AGREED TO CLEAN UP SITE. FOLLOW UP WILL BE
DONE BY N.A. FIRE PREVENTION OFFICER
SIGN ,
THOMAS J. VERNILE
NAFD HAZ MAT TEAM
"SMOKE DETECTORS SAVE LIVES"
North Andover Board of Health
120 Main St.
North Andover Ma.01845
Haul Lic. #151 -OOH
Install Lic. # 128-0
Date Address
11/1/2000 303 Chester St
11/1/2000 50 Willow Rd
11/1/2000 160 Carelton Ln
11/1/2000 165 Bridal Path
11/4/2000 174 Ingals St
11/4/2000 1062 Salem St
11/6/2000 373 Raligh Tavern Ln
11/6/2000 252 Boxford St
11/6/2000 150 Liberty St
11/6/2000 149 Osgood St
11/7/2000 255 Haymeadow
11/7/2000 850 Winter St
11/8/2000 25 Windsor Ln
11/9/2000 249 Carlton Ln
11/9/2000 767 Johnson St
11/10/2000 56 Academy Rd
11/14/2000 Sugar Cane Ln
11/14/2000 250 Abbott St
11/15/2000 195 Winter St
11/15/2000 187 Winter St
11/16/2000.85 Laconia Cir
11/16/2000 86 Willow Ridge
11/17/2000 21=35-T.urnpc ek -Std
11/20%2000 203 Grandville Ln
11/2012000 391 Pleasant St
11/20/2000 124 Tucker Farm Rd
11/22/2000 394 Boston Rd
11/22/2000 728 Forest St
11/22/2000 18 Johnny Cake St
11/24/2000 106 Rockey Brook Rd
11/24/2000 258 Rea St
11/28/2000 1815 Great Pond Rd
11/28/2000 1420 Great Pond Rd
11/29/2000 266 Lacy St
11/29/2000 155 Laconia Cir
Andover Septic
47 Railroad St.
Bradford Ma. 01835
Gallons Comments
1000
1000
1500
1500
1000
1250
1000
1000 Leachfield Run Back/ Ex. Solids
1500
1000
1500
1250
1500
1500
1500
1500
1500
1000 Extra Solids
1500
1500
1500
1000
1500
1000 Flooded
1500
1500
1500
1500
1500
1500
1000
1000
1500
1000
1500
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FORM U - LOT RELF,ASE FORD
INSTRUCTIONS: This form is used to verif
approvals/permits from Boards and De any that all necessary
en
have been obtained. This does not relieve is having jurisdiction
landowner from compliance with any applicableelocallornstate/la
regulations or requirements. law
****************Applicant fills out this segtion*****************
APPLICANT:
Phone
LOCATION: Assessor's Map Number 0 C
&6k a yyq p,
Subdivision (J ��21,;lL� �z g Parcel 55
_
Lot (s)
Streeth ' �ae
9 . St. Number 13,5
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date A r
Administrator PP proved
�ConServation
Date Rejected
Comments
Town Planner
Date Approved
Date Rejected
Comments
��. Food Inspector -Health
c Inspector -Health
Comments _l
Date Approved
Date Rejected
Date Approved 7
Date Rejected
l
Public Works - sewer/water connections 5�y�t%�
- driveway permit
Fire Department
Received by Building Inspector
Date
TOWN OF N
"6�
SYSTEM PUMPING RECORD
DATE:
APRi6"
SYSTEM OWNER & ADDRESS
t
3 S -
SYSTEM LOCATION
(example: left front of No- e�'
DATE OF PUMPING. -0 y QUANTITY PUMPED:
/�I-�'-'-AGALLONS
CESSPOOL: NOy YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
coNTENTs TRANSFERRED To: G.L.S.D well Waste
IL
Commonwealth of Massachusetts
City/Town of NO. ANDOVER
System Pumping Record
Form 4
M TO -1 OF �viJlc v
DEP has provided this form for use by local Boards of Health. Other f rb��
information must be substantially the same as that provided here. Before using this o r ith 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.
JUL 1 2 2006
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
BAen
A. Facility Information
1. System Location:
2135 TURNPIKE ST.
Address
NO. ANDOVER MA 01845
City/Town State Zip Code
2. System Owner:
JAMES CHLEAPAS
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping 6/16/06
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes g No
5. Condition of System:
6. System Pumped By:
Benjamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLSD
State
Telephone Number
2. Quantity Pumped
k Septic Tank
Zip Code
1500
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
6/16/06
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts RECEIVED
W City/Town of NO. ANDOVER `
System Pumping Record DEC 0 8 2009 �J
Form 4
TOWN OF NORTH AMENTER
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
t�
HEALTH DEPART
DEP has provided this form for use by local Boards of Health. Other form I e
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:
2135 TURNPIKE ST.
Address
NO.ANDOVER MA
CityTTown State
2. System Owner:
JAMES CHLEAPAS
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
11/13/09
Date
Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No
5. Condition of System:
6. System Pumped By:
Benjamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLSD A-
State
Telephone Number
—2",Quantity Pumped
Septic Tank
01845
Zip Code
Zip Code
1500
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
11/13/09
Date
t5form4.doc• 06/03 System Pumping Record . Page 1 of 1
Commonwealth of Massachusetts
REC'yVII
W City/Town of NO. ANDOVER ; 2013
System Pumping Record
TOWN OF NORTH ANDD\'ER
Form 4 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.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
VQ
retara
A. Facility Information
1. System Location:
2135 TURNPIKE ST.
Address
NO.ANDOVER
Cityrrown
2. System Owner:
JIM CHLEAPAS
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping 12/14/12
Date
MA
State
State
Telephone Number
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 By:
JAMES H. CURRIER
Name
J's SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD
Signature of Receiving Facility
01845
Zip Code
Zip Code
1500
Gallons
❑ Grease Trap
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
12/14/12
Date
Date
t5form4.doc- 03106 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of NO. ANDOVER
a � System Pumping Record
Form 4
' M
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Q
v fu
-'ed this form for use by local Boards of Health. Other fo
information must be substantially the same as that provided here. Beto a -
local Board of Health to determine the form the;
the local Board of Health or other approving authority.
A. Facility Information
1. System Location:
2135 TURNPIKE ST.
RECEIVED
JAN '-- 8 2008
Address
NO. ANDOVER MA 01845
City/Town State Zip Code
2. System Owner:
JAMES CHLEAPAS
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping 12/7/07
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes [a/No
5. Condition of System:
6. System Pumped By:
Beniamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLSD_ A
State
Telephone Number
Zip Code
— 2. Quantity Pumped: 1500
Gallons
[?"Septic Tank ❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
12/7/07
Date
your
�d to
t5form4.doc• 06103 System Pumping Record • Page 1 of 1