HomeMy WebLinkAboutMiscellaneous - 2225 TURNPIKE STREET 4/30/2018 (3)Commonwealth of -Massachusetts RECEIVED
City/Town of No Andover
System Pumping Record
d
Form 4 TOW "0c OR T'IANI�� /E ,
HEALTH; CPAR �ilAEt
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.
6. System Pumped By:
Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma Q1835
zy r�
re of Hau Date
Signature of Receiving Facility
Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
A. Facility Information
Important* When
filling out forms
1. System Location:
on the computer,
'%� ��e �-
2a;t � / urf)
use only the tab
key to move your
Address
cursor - do not
No andover
Ma
use the return
key.
City/Town
State
Zip Code
2. System Owner:
M69fd�(�!J 5
Name
seam
C� 0 y
Address (if different from location)
City/Town
State
Zip Code
-
Telephone Number
B. Pumping Record
/3
1. Date of PumpingDater
2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Ea-S'eptic
Tank ❑ Tight Tank
❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? RK`es ❑ No
If yes, was it cleaned?
E�-Ies ❑ No
5. Condition of System:
6. System Pumped By:
Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma Q1835
zy r�
re of Hau Date
Signature of Receiving Facility
Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
-o . .
ovam or Health or other muconj rr
or approving. author
F. C; 1111 y. J n r 6 r tion
=npuwl US e`1
only the tab k4y Addros)
Cl
tyfrwn
X3 em Othtnor," :0:,
a a
Ayl.l. ,! �S.:r�).?', , �'. r;�/�:'i�r S,IV I �1,.]r. �+�J �e .l � �J ar!� 'l
CifY/T QoWn ---------
91qVnvn0 NUM0111'
n'Uty
Date' of P
u m n 2.
Date umped:
YP.Q qf.syce�j,
onsT
00 1(3) eptIc Tank ❑CD Tight Tank
'Other
E 6 Flite(P i i n t?.,- 'Yes
WQA�. T q
it Yos. was It'Q1eaned? ❑ Yes No
-*��q'-��-,-.%,,,4F '01
fit
. v:k
it
j
,^I
�meed .
• 77777
. . . . . . . . . .
e'
1,111 ik:iiii� Jcon#o Number
1% A
q
tii!-, 7 L. m;mQ h. Wh e re'PQ b
-- 777777 -
6,
'A 6't
i 4,
77777777t7��
Date
rQm
o -
j
Sycom PtIiMpIng
Ric4rV Pi I
J
k FORM U - LOT YRELEA_ SE FO -
RM
F
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits o -n
Boards and Departments having jurisdiction have been obtained. This does not relieve
a
Y Pp 9
the applicant and/or landowner from compliance with an licable or requirements.
T FILLS OUT THIS SECTION
APPLICANT�iQ/jJ,j�� , PHONE
LOCATION: Assessor's Map Number_z i&
PARCEL_
SUBDIVISION LOT (S)
T ST. NUMBER
USE ONL
V
TION Al
TOWN AGENTS:
DATE APPROVED
DATE REJECTED
s�
INSPECTOR -HEALTH
COMMENTS SQ
i -
L
DATE APPROVED. — �&J.
DATE- REJECTED
-(b���-' s
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
0
RECEIVED BY BUILDING INSPECTOR
DATE
Revised 9197 jm
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH
INSPECTOR -HEALTH
COMMENTS SQ
i -
L
DATE APPROVED. — �&J.
DATE- REJECTED
-(b���-' s
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
0
RECEIVED BY BUILDING INSPECTOR
DATE
Revised 9197 jm
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
**•►************************''*APPLICANT FILLS OUT THIS SECTION*
APPLICANT�xd ����PHONE,�9Z��,�9
LOCATION: Assessors Map Number PARCEL
SUBDIVISION LOT (S)
ST. NUMB a;t
STREET—
USEONLY***" **'*�
REC ENDATIONS OF TOWN AGENTS:
I . - , n
CONSEkVY0ibN ADMINISTRA
COMMENTS
TOWN PLANNER
1�
COMMENTS
y
FOOD INSSP
/SEP C I
COMMENT
OR -HEALTH
ECTOR-HEAL`
DATE APPROVED
DATE REJECTED_
DATEAPPROVED
"DATE REJECTED -
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED_
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRJVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
I/AA/D 'k��
S4-, 1211-y
TE
N/F MA THEY
305.771
42f45-'43
i-
n O
� Q)
r
O
N/ F DEJESUS
C)
r
/Vo tP21 149 //YG
/ N R C) U N L AL F3- N r—tommov
oma ``' • ��
y
SEGa,&—'R Ou.f
�- All< otlLt / 4 C/ - 6!4;
X 13
i
z
7L --
i
D�ovc �� poai
FORM U - LOT RELEASE. FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from -Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations.or, requirements.
*************.***Applicant fills out this section*******GG*******-***
APPLICANT: Phone O - da
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street,///.a(�/V� � � 7- 'i AOT. //�e' St. Number _
************************Official Use Only************************
RECO ATIO S F TOWN AGENTS:
e ation Administrator
r 1 n
Comments
91
Town Planner
Comments
Date Approved. �1
Date Rejected
Date Approved
Date Rejected
Food Inspector -Health Date ApprovedDate Rejected
Date Approved .�
tic Inspector -Health Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
TOWN OF NORTH ANDOVER�h�
SYSTEM PUMPING RE 00 _ 2003
a
�1 1'CM OWNER & ADDRESS SYSTEM LOCATIONx�
(example; left front of house)
o� �Sr Fro n - L e R-
DA C OF PUMPINC; -////Zl QUANTITY PUMPCD15WALLU�,
:. I:�.SI'UUL: NO YES SEPTIC TANK; NO YES
ATURE OF SERVICE: ROUTINE Zll EMERGENCY
X111.>FRV.:\TIONS;
COOD CONDITION.
HEAVY CREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
PUMPCD BY:
� U 1-1'vl ANTS;
1'IZANSFCIZIZED TO:
FULL TO COVCIZ
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
O�HFR (EXPLAIN)
i
/I
WELL DATABASE
AGE of ,N-ter:ELL DL
W
riVi�.:.FLRL�IL1 LLL LOC.�,110N:
—'V=- PER== DA.iE:-
`tUH OF W=_ DRIL=
TYEE0FWA. Ea4RINC ROCS
DEPTH -OF
- 'WA=ANL A.LY=DA=- --- DIGHNLAYGA.N-ESE:
=IRON Y N OTS cG1, �iDAL�TZS. y
''Y T DATAEASE
AGE OF r�=. WELL D Rl I Llul1�1, G°ZC�c
WTLIL
PER,fii Wim' .` .r. LO.CATI�T
WELL PEER, /— — DEPTr OF WE= �'yl l oo
TYPE OF WELL: DRi'i.LE b. DUG c. UNiK-NOWN
TYPE OF WATER BEARL\TG ROCK:
MATER A_NAI.YS_S DATE: /E'� �- NGAN�SE: Y
T 3` � l �% N:iGH tii�
HIGH LRON: Y �� OTTEc-'-R CONTA�i ANTS: Y N
Y
AGE OF r�=. WELL D Rl I Llul1�1, G°ZC�c
WTLIL
PER,fii Wim' .` .r. LO.CATI�T
WELL PEER, /— — DEPTr OF WE= �'yl l oo
TYPE OF WELL: DRi'i.LE b. DUG c. UNiK-NOWN
TYPE OF WATER BEARL\TG ROCK:
MATER A_NAI.YS_S DATE: /E'� �- NGAN�SE: Y
T 3` � l �% N:iGH tii�
HIGH LRON: Y �� OTTEc-'-R CONTA�i ANTS: Y N
.i;., _ r i
<a t f" .
C 4 rot{ S5 Y'� 11
yt r
+ }rt#1. 'k 1. s
a� f( {F -: , . _
t•A $ktf,{r f,� i n 1: ir- 1'
y g !
r.
i _1 t
C,, � + 1 1 i
{ t
,—;Il , t
x
Y -III ag, i
i
S' ,.
c,
11 �
i.
5,,,, lt,r .t. :
}a
F ,Y0
T
A
1 1 ij S 1 t f 1' t ..i
d,t. 1 a q a r•� is .t .� ". # �?�
`' PARCEL -2'
i.-J:'L.tl r )J
I�Y'drtS. A 4r}rJti k"-- ..
a
AREA = 43; 670 s, f
PARCEL — 3
,d r,
t 1 . i ,
:a 1 1 ! . -
tt rt 5 "� o- 1 �lfi i { it j t ii l i 1 i, .
3 i f
w i i t y t {
a
I.
7{ f I?tt Ms j 1 i t* 1 '� t { >' { Yr'{°tyik J f at` t_ �e
V a i 'V°r-.lifer i 1 5rk t�3� Ft:: Z,>-! I t.i,.:__ M
4t I- 4 f,11
t
3� 11 I �:..,,,R,-'i,'
A� � it '�� I e t. ,e � ' �11 c - ". ir{ � 3 . 1 y } , i, a '
4n 7 ,� i . . �t .i t d i« ; 11y-" 1.
y, e,•,�',-?' S y` s� ?#, � t.,4. ! q r�; ,E- It #' t 1 5 fi S rr. 1 3 _ t ,
t ° " / r J 'x'17-�'.a i �1, ' I � s - ,
I, F' 7" 1
rl;Nhmt ! f aF r ', L 4 tt }y t t
i
P , +" k,rt #.z+t' ,,f''.,r 'j,{4 J i'.-fi+t ..i dr - 4 .?;>} y.- � t •� �.5.}I �ti �q t� � ;'•�( *t `t' `+`M. t;,v.,,,P"ill}J$ ��, ,.-; � � e.7 A e t.ui V� �?e d 11 I
;.';,
�, •' d fir. € Y ] £qtr' '� {! �. 1 8xI-,. 1 {, ab Y o- :+y*, A t r:{, '
ii,
. �
�r k- rz :,e "w,a e I { 4µ �
11
All
til
A.
�,
4
�} p� a ,lI � ", 'A' ; . . ��
,zi ,`
t,' r �i Ty,t ai'{ x;t: 'i s ��{J.,i�, , iFt '` '. 4 f..'. , �,�ot t` H r . .
.
+bws,.`1. g m"iu" i. e g ,., a c;t,. t, ��' 3@'a � }11
}a$ i : - _ i -�. + s .
- -vt t f �1� . y+ b i s t, t 'r
�4'rw.%, r¢ r• �f # o {g;,• I- a F to+tT.''a `* rs`/�� +i 2 t� t#
.�,, °`t�: r,_ } t ai p j S7i LOCA/, ED&;i�/Y a :_
rp ?<}�fi,o '! z, I yp F.ti' 4.. f *< y 1� r ; 5 Ft1. #=» .i
a
1,�4
xta rid :fes jr'rts�t f< ,f ! M ?�. $ .J+ �ft hitt .r•. .` r.4 �e { ';,Ft
', �. R� `'� ft.#q r i 3ie. 0 ,d F 43 � i I t �;f: s- ," ° '.e` 'y ,c„F, t{. i'. k
1.r _ - wl 9 - NORTH : AN
«�,r �� J.�, w 4 + DOVER
. I
�{71 a5 '3", c s k �.1.,'� i. " I ,r +� f i -. _ 3 . I_. y{ ; _ .. k-3 .t t� I .
�`'J'r ar,•- - f.Tn t 4 t,�•} 1 = a X+ I .;.f
_ # ; „- e , .- .
�1NDAT%ON,,
.1. 4�r$v' '` r f a +, is _ e'+ , t r k t t '
i'.�1` -t. - . `: j .f- S. 't' t ,e. e FOR - I - .;,. �. I! ,
I �
-
`.
+,e
f''t' -.� C i` 1 l� t+ F _.: i y �-s r i7` $... # r + -.# 3 f �'d' - t , . f ,a. t e ' a. -, p " -
.i , a..�rt3? c'ni, r ii�, i e au -3 `} ''` J ; ,i "i e a j- 1 r t j ) s rl. t,�^.� k '"orf^ # : }; Y., z, k r a - , - •
'' a,ri. 3 §a- '� a� �t�?y r"' dt ; 6r a F+E_. --� '`� (O i.a�, ,r" ,t",
. ,n7 ,{ .d� {ac:$g a t�� # q 2 rl.;r 'I!., t-.� p ' t {a e e $.{ t
t� '. t {y'. Y .,.ss.., i ri i s a t e., ,- C i,
;t ki..# t 'S. } is R.."7'L t'� OGr `g} ..
vt;"i •r'> 2 >�a !'^% L�y�., ry;'} s ., y .. ff {€,, s; t� :$. # S : 5..,a �� } ' e #' fF RA ND"' f jc ¢f D
4. }?I :. r MEA .�
�P,,I 11 y z �� . 3 i cs.-. t ' f
AAt,z11 s P ;, a d{ c 1 '
�,x { .SCA L E l = 20 DATE ®6-
k'_R " x�l L + 4 i �' , -� . s cr.. .i . - * .s -r r i :`d,K'F , 1 • t a- WQ,? ', i ,, ` ."z' : 4 ti - _ _
�x ' S a.
tt,, � #,ts�'�t, , �> st c eta -:` :. t, wg -,t { a' x .,
r fk"�.`�` �# - 5 f? fs;K,tj :Yt 4'v '�34# t�� �t �¢t�t ., M .1., s � ,t _>; �. A',, r.�, { �" ��t-},i :, ipt
'�.} ,, , f z ,t1:rF R {s r, ;;-�� ri xr4ta 1 as � d.k SL G/"LES R.L S..n LAWREIVrE
, ° �1 4� "• "-. �t rt 4 Je a F$ .1 ;f.4,. w k;{ F s ,� ,, { -'7 :. �� a, {N ` y, 1�1, { r 'x z s t: a "." d 4 :i - . r
',,.j ga t.;�'� s�Ir 2 t rata 's4 # .1. aif a t, ! � F,, i': a ]int . .
i�. 1 �y4 « via `�# e! t 3 t{� 7 t S_ ii { +`�'t z' 4, t
a 1 1au Ij
qq i 9 gg 11 it 3
d" 1�"f`s'ilt ,Lii-9 vt#" + :--- x P{ e11 11! ,It �jxz t S�. t I �1 ''.ir3 ti ° 1;:1 'k' . li ' -k i'r } S..*ts i.. 4 q,
�1 le£ a i 11 `rrY �- 1 v r:' d i•` i -tl. 1, I, - kl ; ,. rt, °' j {�
,L '•�1 ,if a."y,`i.., 3 .t, ¢`id vFi _- }, r. -ti i d'�, a �;,l ' 9 t�-r. S{ 1 i ;9 l t ° ` t i -
',' ,tt�;ii.e , # a 1f ' �' � at �,: :' r i s p 7 F` , 4tY t ,'' ,; f '} .4'. a ,. f t a it.i.
r. s , } ,; , r t. " / CERT/FY THAT ,THE +FOUNDAT/ON SHO
{,o 'I0 . i O {' ;$.r f t`_ �t : rse�• z K i . ,r rt€t j'�a #} 'r t.i t ', a at A - T:: 4 - I if i . £ � � '
r �a< I ,s ,%" �, n }'. "� 9 a� t I x tr I t t to E y s
'�' i r4' ,>,e,.,r ; ;. re,.� ; , PL`ANC'ON .FORMS TO :TNE. ZONN/NG RYi
:.? 3t
r:=`r°kr •'7 % p1 ;g f ,� 7: r, i kri:'; `+~ i5 s: r ff.12 'o--..' y� `f.di r of 1:`.'i 1- • f.y." t , a;'.i '
x 1 .k.
{ ?;
�ii';5, �,, 3, ,, _4}� ,: ; , t TOWN .OFF NORTHe ANDOVER :WHEN iC;O
, , e n
a{r v.t"'t :!`'.. .<q of __ t{.,rel` .-. 5'� #`&a. F. '„ �"`#'. i�:'iM .y:},'v f? y?yi,: sr`f' n F -{ + ?':r ..t 'i -4S st, rya ,:i .a e —
i } zcy.: r ,W , , Gx k ^ Pfi , 1{. , r. i 4.. slt � 6 i - , t+� r'". -e 1 rer7,',41 1e t : : v !
�„J %'fit `"M >h r I .t,.�.. x -.. r t 9 ;� a { ;.�.. .r%.} %, . .3 .-(..:i ipi kj. 1 I x , a - t. s„ 34 x s � .,.�.. � 6 ! .t 4 ..y, date to
't 3 # ^ i d
I l�,i r .-,' . $8 Y ..ii�.v t' _ ` .e;t �•e «' ` t . +.j ; (:r. 1€ 1 r I ;' i aa...S'f t; ? .4::,r` '.. r,'i J � h ;_{'r I •t ::, Y
' < 4,). > '� i' .,.,� 2r `Y r ;{- ix -,r'=. 7 -,1. .," 4 'i� rr': ,�T. �i-..j I`ti� r.:,.4 i;, f,. dei t
w t 13'� ^'+ t *i jr'^ " to �,:z# ,n ,$ ,;+_'�•�1 t" 7 , ..;. F. .i a.- �a'i t fa 4 I `rr,"" jpp'.t:`' „ `.gas:?}: t � +�
, , . 4, .1 T t y r ,a ,fi ,} :S�'7';FF°v N F7',# i �s j'.. plTd-��. '.., i i aR F -y t e .' i L t # R wj t 1 .-
«. x $: , } ,x ; *, I fi; t 11 � .4: r , al'.. � ,OFFSETS:ha K {e✓N1 - F
Rix rr .= f.. ,.f,1, 1. , .{ i .S ', I# S, O RE4. :OR iZON—TWNG
s r, z i q
yJ%. �: .. �A r: ,ye , teaq ,}}p it c:i'i'.;3„ _I t : .:�E _ fa f ,l_•._,:, s, u•! ."'.;s.R% I tt (r ;:;x 9 -t ''F- _ i.
�? �..{q Y. E. .I .: aR.1. i' :.a i" §' d'- X,,7.. r, .,q - ,L_ `.i s. ..tf
yp, �r, f,,. 1 :.i :is i:b• .:� r f,. i' i - :,,. .. .xr- , 1.. i- � r 'e JS i tf.'I -_4 i4r -1,` 4 I,'I .}:.� < .�'.. e � I � ..Y ,
L:..• { a 4 :=:.•,ez P .! ':. ;;.E :.a I4- " t w '; F �' x:'a' ,� , :I.. t,,, : q'.L. =I # x. '
"��3 :it" � � �, � � d a`�: '- .t �, r .. t. �. ��� ►, $ ., fi , ETERM/NAT%ON>F.O LY' L� ARE''`
�; '�'F. �.... -.1 . ,. , .,,.; a. .:, ,, 1 :� . , r �a:,, Nt. ..� . NOT TO t
.x.,.. •;, ,; Z ;• 1 w.: ,• . +,,:�4. a „j � a .;i -v {{s,�. a, a, '� t { t (..i ,c $- e a moi: 1�€ i`�;_. 1-1.45,4, 1 t ;, a.
+r #. ? � t.. "�.- -s.. q�, W i,.,d y q4't. }' .tJ. 'd 1. a'':f:: � j, `'$ - ,t t•f:4ii' im1 { dt t l ,. •tv:.. + - -,. Y I',s.t,t
#, J 1i., = I f _ ., t _ B fU5E0= `TQ ESZAL/SH,' 'PROPERT)'::.L/ E
;t, € � � ',- � ;.; " , � .' eF t , �w ; ,,, { I. .0 i � , k1, KAP ,.. I,, N S.
•'�u" ti -.r' 1 ' , >;. r , 3 �. ,.;� � 4" J: ltd s.,,s s � . :,. { ).�,'s t'#. � .' �a'- �`4 d,(�,,. t ..I""- f � r. 1 a i
5'? ''.,i<'y�- . L:a:.` a el .i ! �` =` , uv :g: g3,6r�' 4, 4 k>� & °f 14iI;,��3}gg;i , !�, ��ks!^{_.,� 1 r.,, -fit= <. 55.t� „ir ^sL 4,�,� !:#¢d e -'�
11 .L 4 ,,tFl,t r;"�. E.Y {' fi+? "SA ) i'.y E { j 1{ pi i 'F,w :! -C: ,F '� 'i
a ,'L s'9!{.. } 1< 'd},fi t* .:. et � 1 . 8 et :7° ;'"4 �1: ak ¢ j �,.�-: •e` , T"�`+j[,i ,1 .':�4 ° o-:. { °G(`:' ,F lye "=�._ I, +'
t i}tr � .y;•. 1. a$` f� a 4.. }; 4 , ". t s r t. z 1 .,. 1 < + J t • .3 E
+:d?+' w., :., s,a t..n�,1r. „" :� 1a.: a'�.a 'i}�r+r .�..,:,_ tr ::a� .I t}:. y t F f wt.;i 1 .'. �'" 9 'pp
1., 7 1 " z i 4'fi a I; d i, : ... ,t s ; P f� ,s Ir t" t$ i S
4{a;. v.� ,yr ,'y�, ,�..:du`at..3�aC S_v_1 ''n'.r{u k ��'.,xv7 ,a -e. + ,.:z: - s ';e.« ` _+- t z ,�-lt`�k Ct, {A r a ., J ,f.. i E I.
e,f. �.,rf-1"ki>�'+ ' ';• •"' itW. . li :�q,,1 i.� rS^ty i� y.44., ', �{.Y r `s. .,; j :�` } q � -..di t "7-; �` � * !�" y, E° 111:. m{2 Pig i, -ata n: $t,. 4 11 "' "t.'
`e, a i aft ,t -r ik^ i ,w a as >rit I vx b '4 '3t:[ r ' I`''�'. - t � � �t;"' }, � � r *i � f
.. G9a s.,- > ;,a ^f" 'i SLNIFy,i t.,"xti r. r .I as..r w t}.4' •""P"4 t3`- �'_. f. r t., # y$ t' .. -
:_
'".a. '' r, �p . '�3` I�tt a 1 say v'1Aa 1G� !i f!' a' •' x �'f 1 'rt-kC �{,. 1 -''t;a ! 4 /S.I { N A; - Ri
, :.,. uy 3. x .. y, i t €.., • r = a >A: t'd f i.. , : i t . +u, { it i.�.j=��.. TN S QT { 7 + t a
„o g {' q / O T / FLOOD' hIAZA
",� r*. �„},''yt, :rte .`,< d' ,. -s, �.:.n" 'If r I' .A7- l y 'i Pk sp 1 if'a ,; I A ;,v }. !', vt �� f i' a >;� +' y 1 3
1 t r -s11
i � € i ,/ e a
1*1 � a �yyhYpe � �� s to -ta ' `r r�r �x i fxt t r E (t *a: £ p �a QG� .�/ G -�7 ., ? UG 0a `k 2i
i.° wp..5ro ,K,,, d�t'.W i� 't(j. I k4 I w`fl 4
Yw Y*',� :1 `'. I iI �` f t h 1 i4 r _, e"i, p { p ..
f Ft '� C �a t i7 f r. ,'ir i i i } t I !,$' a.:x 1
• r"M�< t 1',, ' n -tom "':-j 4 a a` , a� r's'' 1 s x s 14 k y I
' : � _ _ ;> ., , ; � s+ 2t s .° , � i" (COMMON/ TY- PANEr.
dro,;, 14`kv, $r sro+ " !; at5 ,} a'd s+ '4 , i t 1 } t a
r ,?� t,j . t4j( i z t�? f� , ";; 1 ,��� - 1 ¢;xa f ,5 j L ^NUMBER 250098
,I pf � M1 ,1 4 3! it + � v r s' # t", iit., i ;. "t { i tri' -
g 4:. ..�. '+ 1 tf$ f# ~;*je 'x. h's� ^-iiV i�' y��/�L'J 'fn 15�'X +, i � i t. •1 y . _ .
"� r € i 3 J- d+• t i t . ' r , t731 1 . a i 4 , + 1:0,' _ ( - s
'i t !¢Y}, K t I i1',.--tI -1t?�' �j ta,ey l c ' _- t e
y ;?� t li,td „Y.1 : ,.te � f t', i4e s # f ¢r , { r d t '. -
+.,i'•" fps }" r'g 'f" ,x �. I t: < t t �1` ' pts ,�', d"'� � � ' •""-Pr - �
a ._y., _ r tI f t L.-
-4 t k ♦ 4 �f d - ' at of 4,
R} ry 1. € �,
°* ro F ! ,�a r �, ' i i d .� F i e ;;It i C\` t - • � 3. (/ �.'�c
I � kik ,. a 9 § 4 i y k�, i F p ` i 11 (f . t i.{ t
:'�{ _a i;. y ,.,,::p' .f�;srr -i}r ;r.f / s # '' ,9 - - `;. Q. iJ�,
ri i ft I > .v ,yfi E ata 'i ,4 11� a - .�' a ..K . i r e i e_ E -S €.
Iv. , '>Mi} '} k . , y k 1 �a �' S r ., = - 1 . , s i_ � i. ..'� 1 I I e.
r,�e. j.. i ,�.; 1 t, i,r♦ I �r , t e F fj�+.
3 ro � I , } k33 23 ,
M i ��# t i t e 6` t i t Pl S Pr h w .I
y -, , ,,t t 3 sy Fxi v r t e,11 r ti ,-i ''i d -'c
XJA,4�4w = ad s '&1��t`�.�'.°r s #ja a', . i �i 1 I 14 , .1 i t
gh" &}q '` t' { '� �@ i. 3+w'frx ``'� .i.t BF# t + r ta.i -•..f , - r . x 4•r `>, r {.2 i -}.:, t
141"''!*° 3 r ; y : bt r • :$ , xi 1. d r e ai c f' 4 r i - - .
17 9 r f I d_ f .� e t ,� ta,'r t 4
a, e S
a ya• ;
1'x
v 1'tF std 'e- �`j,r fP r,.�,1a r ,C'�j Sca1j �b1Te } +„",4" ,it,
ar "t ii. ! ! -
;
'$`X '' a "..'t �, -+. 4 t - a i„ r wn. ,.,i, y y r : 4 $ , .vJ, =t r a y; t, r .. 1v _ v n
$`@'',PX”,"rr }"v i. - P41 r -. x .j`-�A 1, < re �a 7 ra J' '• "
r �. � �... t t �.aa X ., + } kxi,. ,�- _ x „fit t, r x'17 .
a,i ro hr . t r 's
FOr
'r n s - .: +,t .t ,� ":z t x F 3 t "3 1?r �, al114�1 .c t ,� } , .
Cxi p�, F' "et Y.i , P_ t.e . a i - v F,:�, r i . �" ;rt d ]k>r4 r;: " �` - 5 S q
t;. '„ { ,,ttrr�� ` b' Y Z t bt ! d Yr F is _ p
'?d h�1C �'F,saL" `tk.#"ts+ Y k J 1� 3- F \' f F
P41, ya r, , -4;,
#""r .x ._ j ^r5 # ri ^d Y,�. aF e y r t:1.r i+' "I It '=: 3 ";e k i t
+i tr a '�' _ x� 'v4 , q"� I, - , ! ..� b_ a (f ."t z 4, #, 7,11 ^,,jr°i.. n : t `'t
1'.{a !} a 2, 7 f { r JJS, 1 ! . t 3 y q ;;z f i FI.
t fig I, t z. F 11 . 4 r 1dtt I t .-. v ,it .+ ?^ `'
=:rot ,'I. } f ,cid ° C. r= t 1 i t t ! f a 1j- ! , ..I 1 �- {-
AREA - 43,670
A ear
WrE //4 )
0
QQM
n
4tf
J - r 7�yt `Sati�
` '-` �, ! . Int s •� It { 1
! t !'
�t t •1 �t t `�� b ,fa ` �'_
A i
x►h 4 ,��yT» PS , ti
N�
LOCA rEo IN
{ r { y
• �1' �i ,� '6� �* �i a .}a .�� � .{c e " ;.(: + � , t t � < �, $, '� ��r�(�� "'�,;
VEF
I ®RAW Onl SHM�4 S5� Flit
f
FOR s, r yxr ii
x Yy,.rt,t !`p
p
RANDY MEADOW -s -l'", } ��
�t dt
s
SCA LE / = 20 DA TE. 06 -ml
10,
4. w
V
S. R. LS. • LAWRENCE, (MASS
ir}�f yrfyfY y`,.
I CERTIFY THAT THE FOUNDATION SHOWN ON
PLAN CONFORMS TO THE. ZONNING BtGYLAWS _OFTHL�y�: it
TOW�oN� OF NORTH ANDOVER WHEN ' CONSoiv—
TRUC TED r
date / s.
OFFSETS SHOI4lN ARE FOR ZONNING
DETERMINATION ONLY 8 ARE NOT TO `BE
USED TO ESTABLISH PROPERTY LINES.
44
THIS LOT IS NOT IN -A FLOOD HAZARD ZO`NE(r
.h
date
( COMMUNI TY- PANEL NUMBER
2500-98 OOiS B. J k
- ApF+.AALI „ �S• Ark � <.7,
"n�• / / , ''ar u,, ° ` `... J i 4994 iwy .�rt
--- 33.23 i
.. �'�•�. !��'¢ �i'°�i °�.; rw `ir t5 e Fat � '.••f
RV
t4 fti Kr • r"
t 4r
.STREET
;ij IqZ4 pug" I -
'a,
14M,
TOWN OF N R.TH ANDOVER
f
D A Fr. PINQ RECORD
jo Ll
SYSTEM OWNER & AjiC)R_E_SS
ly)leo dow s
9 a c95 -7u- rnpll&
A10 .0A1r00VCt , r0a.
DATE OF PUMPING:_
7—RECEIVED
OCT 0 5 2004
TOVkIN OF NIOR"("H AN[ -,,)OVER
HEALTr-
__-
SYSTEM LOCATION
in
��
QUANTITY PUMPED:_
CLSSf'(X)L: N0__._l.. YES- SOPtIC I'ank: NO- YES
FL
KE OF SERVICE: ROUTINE _-/ EMERGEN('1'
013SERVATIONS:
GOOD CONDITION FULL JYJ COVER
HEAVY 03.kEASEBAFFLES IN PLACE
ROOTS LEACHM-LD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER,. -,._A__ OTHER EXPLAIN
systom pumpcd by
L 57L,
------- ------- -
CUN I LN 1',%j I"KANSk'hRRED 11) olz 157 /#///- J5
Commonwealth of Massachusetts
W City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
Form 4
,G1,N yye`'
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
rehsn
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
1. System Location:
2,:P /1Z
Address
City/Town
2. System Owner: r.
Name
Address (if catioa)
RECEIVED
City/Town
MAY 11 2006
TOWN OF NORTH ANDOVER I
HEALTH DEPARTMENT
Pumping Record
Date of Pumping
Type of system: ❑
❑ Other (describe):
Sta e
c; r4W,7(f
Zip Code
State Zip Code
9�'X-W��-�a�/
Telephone Number
Date? D 2. Quantity Pumped:
r Gallons
Cesspool(s) Peptic Tank ❑ Tight Tank
Effluent Tee Filter present? ❑ Yes V 0 If yes, was it cleaned? ❑ Yes ❑ No
6. System Pumped By:
Ana0ve - i
Name Vehicle License Number
company
7. Location where contents were disposed:
E
http://www.mass.g
Date
T/
t5form4.doc• 06/03
System Pumping Record • Page 1 of 1