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Commonwealth of Massachusetts
City/Town of . ��a f
System Pumping ecord
RECEIVED
Facility Information: AUG G 3 2015
System Location:
-- —Rea S�
Address
City/Town
System Owner:
Name:
Adress (if different from location of pump)
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
5
Zip Code
City/Town State Zip Code
��--7?y- Lob S?
Telephone Number
Pumping Record
Date of Pumping -6-/&j /is- Quantity Pumped gallons
Type of System -A -Septic Tank Grease Trap Other (what)
System Pumped by:On/Ank) P'f) �u-Nu
Company: ROOTER -MA 46 Portland Street Lawrence, MA 01843
Location where contents were
Signature of Hauler. -n/t,( Date
Commonwealth of Massachusetts
City/ Town of NdojQit
System Pumping Record
"Facility Information:
System Location:
Address
Affiffill
System Owner:
Name:
Adress (if different from location of pump)
City/Town
Pumping Record
M
State
,tIIZD
JUN !! '01Z
HEALTH :: C' w.ARTMENT
Zip Code
State Zip Code
gnu -
Telephone Number
Date of PumpingIf s- 1i�uantity Pumped J, ow gallons
11 1 41
Type of System__XSeptic Tank Grease Trap Other (what)
System Pumped by: {/k
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
Location where contents were disposed:
Signature of Hauler
Pate & L
-C� f,
ov- aJ-
A/311-ssuchusetts
limpin g Record
101-mation:
---------------------
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Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
System Owner & Address:
Mark Sateriale
258 Rea Street
North Andover, MA 01845
Location of system: Rear yard
Date of Pumping: May 02, 2013
Type of system: Septic Tank
Gallons Pumped: 1000 gallons
System pumped by:
Service Pumping & Drain Co., Inc.
S Hallberg Park
North Reading, Ma
License #: BHP -2013-0098,0100,0765,0096,0097,0099,0101
Contents transferred to: Greater Lawrence Sanitary District
RECEIVED
i!AY '15 2013
TOWNFALTH DEPARTMENT ANDOVER
ate: May 02, 2013 P17111111 i Technician' JN
This is PROPRIETARY and CONFIDENTIAL information that may
be used only by the Board of health for regulatory purposes
12 Z012
Commonwealth of Massachusetts TOV!"N WkORTFi�4VDOVER
City/Town of
System Pumping Record
Facility Information:
System Location:
Address
City/Town
System Owner:
Name:
Adress (if different from location of pump)
State
Zip Code
City/Town State Zip Code
q75- 79V -J- 7(0
Telephone Number
Pumping Record
Date of Pumping j 1 / Quantity Pumped gallons
Type of System X Septic Tank Grease Trap Other (what)
System Pumped by:
_ Fa2ffy- 22W=2:1
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
Location where contents were disposed:1 w
Signature of Hauler Date % I %�-
Commonwealth of Massachusetts
City/Town of n () Y-01 1�vd 6w- Y1/'
System Pumping Record
Facility Information: JAN 0 5 2008
TOWN OF NORTH ANDOVER
System Location:
HEALTH DEPARTMENT
Rea S
Address
�j G d0a Wws
City/Town State Zip Code
System Owner:
Name:
Adress (if different from location of pump)
City/Town State Zip Code
Telephone Number
Pumping Record
Date of Pumping I I I I 6 u Quantity Pumped 11660 gallons
Type of System -kSeptic Tank Grease Trap Other (what)
System Pumped by: V ' --1 l
Company: ROOTER -MAN 12 East Dracut Rd., Methuen, MA 01844
Location where contents ere disposed:
Signature of Hauler Date I /
Cannl"Waft of u
N. ANDOVER , Massachusetts SVSf
RECEIV
JUN 0 9 208
TOWN OF NORT
• HEALTH DEP) "�'L7OVCI
MEIVT
System % er -SYS-tem Locanon
MARK SATERIALE 258 REA STREET
Date of Pumping: 5/07,08 Quantitp Pumped: 1000 gallons
No Cesspool: Ig
• ® yes. ❑ Septic Tank: No ❑ Yes 0
RAGGS SEPTIC SERVICE, INC. -
Sy stem Pumped br:
d.b.a. E . A. COMEAU SEPTIC License
Contents transferred to: __ FITCHBURG
Date
5/07/08 Inspector RAGGS SEPTIC SERVICE, INC
hF-A[,'rj,-1
Fc�fM 4
C ity/Towil of oh
41 sy-,,��teu) purtipi
QI;P hay (aiquid c2
v14 this fcwn for of
local Ea0arg! Of Ha.
a th or7,he
�hOO'APproVlng auij,Qrity.
t " - Low�jjo(j:
Atic�re
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Ntlnj�,
RECEIVED
DEC 17 2007
TOWN OF NORTH ANDOVER
,-,H-EAL1[H DEPARTMENT
Zip
. . .........
pale
um Record
Oate of
-rypE Of SyWtifll, Rjrnped-
EjA�ePljc Tank
[I TiQht Tank
No
rlujllpq� Qy:
-Nit,-� �-�....r.._�__�n-.�
Chi 12 EAST y DRACUT ROAD
111UHUEN, MA o1844
7, } Qcation cOnterit2
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IS: 12 97 868 -HR- 476 HEALTH
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(001nl�nonwealth Of Massachusetts JUN 9 200\j
tk TOWN ()I
City/Town of NORTH AND0VE;nRjMM_AAS5*S5ACHQSETT HEALTi-r.'' H
I -It
— ----------
System PUMPIrIgReCOrd
FOrM 4
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
:niportant:
Mien filling out I- SYSturn Location:
fortis on the
computer, use25E
S
only the tab key
to move your
V-7 ger-
cursor .. sic �7ot -o
UsLh the return LqU
key, State _ Zip Gude J
2. Sy'%tem Owner
�- AddCeSs lift
"f*--ent T
Stale
-fWieipt—lone Number
Pu
InVing ecord
Date of Pumrjjj)_q
�hq
DAlto Z QuantiryNmped:
3. type Of system: El Septic Tangy ❑Tight TanK
Ef Other (desclribe)-
4- Effluent Tee Filter present? E] yes No
If yes, was it Clea
5� Condition of Svstetcleaned?C] yes I El No
6. Syst m PurnpedROOT fq:
R -MAN
12 EAST DRACUT ROAD
METHUEN, MA 01844
7, Location where Conte, -Its we,.
..f A , - — e disposed:
,sinn a
our(of Haul
Zr
1-%rM4.UL,c06/03
htM#11jsPC-.Ct
Vehicle License;
'5y'tern PUMP;,119 Record - Pags 1 Of 1
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h RE IVSD
TOWN DEC O62
UA i't /� �� SY9Ti✓1,•1 PIJMPIN(J P-P-Cpk TOWN OFNO.RTHANDOVE
HEALTH DEPARTMENT
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4LroaAKAYo �""' ONER'EXPLAI?q
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�'�MMaNTs,
UNI•�NptX.1Nyt�X 0I�. .
0
y
William F. Weld
Governor
Trudy Coxe
Secretary, EOEA
David B. Struhs
Commissioner
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION �-e'vd `-all O
�<roems �
Property Address: _ f _ ci h Address of Owner:
Dat: of Inspection: Jd %�c1 U S !� (If different)
Name ,of Inspector:
Company Name, Address and Telephone Number:
AH o o v-- S PPF f C_ ,G,< 7 �iw�► �,o sr- ,%'�`%���-!i
CERTIFICATION STATEMENT
3 I I-- W7/
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C, or D:
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES: � %. A
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95)
One Winter Street a Boston, Massachusetts 02108 a FAX (617) 556-1048 a Telephone (617) 292-wW
%4) Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION continued)
fe
Property Address:
Owner: t
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
,f
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /�. fi
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feei to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm.
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
�ERTIFICATION (continued)
Property Address: (%oZli / n O
Owner:
Date of Inspection,'=
D] SYSTEM FAILS (continued):%
y
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 slay flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
r
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS: /� T/'
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: u 6�' ?' c7 f (� v a1 Y e// 'A' D
Owner:
Date of Inspection: j l �—
Check if the f<P.Mping
llowing have been done:
information was requested of the owner, occupant, and Board of Health.
_ Nonplf the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
.1014 ng that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_;-,,built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
"-'T b system does not receive non -sanitary or industrial waste flow
T site was inspected for signs of breakout.
A system components, excluding the Soil Absorption System, have been located on the site.
�Aj
septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
, ' aterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
_ T size and location of the Soil Absorption System on the site has been determined based on existing information or
pproximated by non -intrusive methods.
_ The facility o„ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub -
Surface Disposal System.
(revised 8/15/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFO TIO
Property Address: f
Owner: U / /)y 0
(� �G►�
Date of Inspection: �•^_� y _
j FLOW CONDITIONS
RESIDENTIAL:
Design flow: gaIIo
Number of bedrooms: ' L
Number of current residents: �T
Garbage grinder (yes or no):�
Laundry connected to system- slyes or no):V
Seasonal use (yes or no):�/,
Water meter readings, if avaijjjjjjable:
Last date of occupancy: �`' �' �� e d
P
COMMERCIAUINDUSTRIAL:
Type of establishment: A/ d.
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non -sanitary waste discharged to the Title S system: (yes or no)_
Water meter readings, if available: 3. a /n 1 b e— / i r. C t%
Last date of occupancy
OTHER: (Describe) _
Last date of occupancy:
PUMPING RECORDS and source of information:
GENERAL INFORMATION
System pumped as part of inspection: (yes or no) 4e S
If yes, volume pumped gallons
Reason for pumping: x.,,14 If t r[_ el .4
T'4y<<- ,rj2 UCrefAl
TYPE O TEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no) 0 .
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 01 i5- r— /2'e a ST /",/ '4 v {
Owner: '� v d /H o
Date of Inspection:�� L
SEPTIC TANK:_! S
(locate on site plan)
�Oncrete
Depth below gradeMaterial of constructio__metal _FRP —other(explain)
Dimensions: k /l S I S f T
Sludge depth: T' Jer//
Distance from top of sl /dge to bottom of outlet tee or baffle:_;_
Scum thickness:
Distance from top o scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: J
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
GREASE TRAP:_ At 14
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP —other(explain)
Dimensions:
Scum thickness.
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom o+ scum tr, bottom of outlet tee or battle:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 8/15/95)
6
G
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
% SYSTEM INFORMATION (continued)
Property Address: sy,
Owner:
Date of Inspection: C G
J w
TIGHT OR HOLDING TANK:_ �!t4
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_
�l� S
(locate on site plan)
Depth of liquid level above outlet invert: ?fq Uj
Comments:
(note if level and distribution is equa!, evidence of solids carryover, evidence of leakage into or out of box, etc.)
Aj'ow 0157,121 9Vr10jq /lox
PUMP CHAMBER:_ ! /
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95)
7
Property Address:
Owner:
Date of Inspection:
e� Sr
5--1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
?-Co 5r- /4, 4A-/DoWIo'
SOIL ABSORPTION SYSTEM (SAS)JI& S
(locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods)
If not determined to be present, explain: {
T0
vt140
,f3q ,-1 S/7C PJ66i.y4
Type:
leaching pits, number: 3
teaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
V
CESSPOOLS:/ -
(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
_ PA.
PRIVY:
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (co,�,ltinued)
w 5- g,40 c3 51- /-,/t/ l7 O u t �/
Property Address:
Owner: Gv
Date of Inspection:``
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' 1/
Cv
. —
60
T'''om r5.
A
QX 'I w ``I
owe/41-4q
DEPTH TO GROUNDWATER
TU C IS
81 -GC _ 021
/� � + C 41
137,v 9 301
i
Depth to groundwater: 2 ,- feet
method of determination or approximation: �y f E �`' "' h-1 a
W.A' TC/Z d 13 Sr l.-vp J Lf�IVX1e- 01,
I
(revised 8/15/95) 9
05/11/2000 15:57 5083736611 STEWAPT/ANDOVER PAGE 02
AkNh ANz)6ver Q -o. ►+.
1a,b Mo,n St.
Na iih A rladvei-
Uaul Liz -
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'�S�al1 L_rc
STE3dART IS SEPTIC TANK SERVICE:
9 7 RAIIRoAD STRZer
HRADFURD, MA 01835
978-372-7471
MOND$ OF
rC MMY REPORT FOR TCW OF lam/ :..i
DATE
ADDRESS �V
.3C /j rv,
o
North Andover Board of Health
120 Main St.
North Andover Ma. 01845
Haul Lic. #151 -OOH
Install Llc. # 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 2135 Turnpike St
11/20%2000 203 Grandville Ln
11/20/2000 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 Johnney 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
oft, A
v
T6.:" OF NORTH•ANDOVER
SYSTEM P'UM'PINC RECORD
?>N -STEM OWNER & ADDRESS Ipp
(SYSTEM LEYC'A'TI-OW
(example: left front of house)
U:\"I'E OF PUMPINC: �,QUANTITY PUMPCD., &uiNLLU�,
NO LYES SEPTIC TANK; NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
WS
GOOD CONDITION. FULL TO COYCI�
HEAYY CREASE BAFFLES IN I'L.ACL'
ROOTS LEACHFIELD RUNBACK...
CXCESSI-YE SOLIDS FLOODED
SOLIDS CARRYOYER pRHRR (EXPLAJN)
PUMPED BY:
cU);INIENTS:
UNT[,'. T' !'RANSFC' RH, D T0:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING R-ECORD
�l ENl OWNER & ADDRESS
--I - 5 2002
SYSTEM LOCATION
(example: lef( froni of house)
U I C OF PUMPINC: / QUANTITY PUMPCD_Ax_C,;.L`:,)
NO YES SEPTIC TANK: NO YES
',-xTURE OF SERVICE: ROUTINE_ EMERCENCY
mFRV.\TIONS:
COOD CONDITION
HEAVY CREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
>1 > I LM PUMPED BY
u �. I !:,'N,I" . 1IRANSFERRED TO
FULL TO COVE 1z
BAFFLL;S IN PL -ACL'
LEACHFIELD lWN,3ACK...
FLOODED
Oj�HFfZ (EXPLAIN.)
TOWN OF NORTH AN[>0VSp,
SYSTEM PUMpINQ RECop
UAI 7119-�-_- D
SYS rIrk OWNER ,& ADDRESS
SYSTEM L."A I JUN
r/ :i L 00 ,
5-9 pea
(glvdo ve'r,
DATE, OF PVMMNQ:__.
-.---_QUANTITY PUMPED:
Vt3SPOOL: No YBSR C IVED
Swic Ank: Nu. YE
NA rUKU OF SBAYIce: Kou'rINE MAY 0 6 2005
TOWN ANDOVER
01000 CONVITIQN IFULLTYJ cove
KRAYY ORWB BAFFLBS IN PLACE.
KoOT5 LBACKRE-LD RUNBACK
OXC5361VE SOLIDS TOWN ANDOVER
HEALTH DEPARriViEN
FLOODED
SOLID CAlAY0Y3R,_.., OrKER EXPLAIN
NYOLOM PUM434d by 0,
VUMMENT3.
-.:vNrem-� rKAwexuL) ru`' /
io
,`•��. I.�t.��t�,;�l'•t���;:: '•i',t.',:u�j�l.;;�iYi '11i.���:!!�:.; �:. ���. Y:�!r��''..`.
. .!i ..IG itis ir. 1}ik'�Y✓'i' ; *I.Y .%'�`h�'yi .'!'
TOWN , F'NO$TH AND `
OVER
sY8f M PUWINO RECORD
DAT$ 5 aD
04 •
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
asp �e.� s�� ��� •
NO' qN, 0 ve1;e,'
DATE OF PUMPIN4�� QUA.NTITiY'PUMPE)J
CESSPOOL NO YES SEPTIC TANK NO �J
----- _ YES
NATURE OF SBRVICB, RQVT�NE ( MEROENCY
OBSERVATIONS:'' ;
GOOD CONDITION'° `' FULL •TO COVER
HEAVY GREASE: BAFFLES IN LACE -
ROOTS LBACHFIELD RUNBACK
BXCESSIVB SOLIDS_ _ FLOODED
SOLD CARRyOVER� OTHER EXPLAIN
SYSTEM PUMPED BY
COi NfENTS:
CONTENTS TRANSFERRED To U
FERRO �.
TOWN OF NORTH ANDOVE
I ) A 11. SYSTEM PUMPING R-ECORI
SYSTEM OWNF,R ADDRESS
A16. "9�Pd6VQ2-
0 y li I�PM L9CATION
DATE OF PLIMPINO: —7
CLSSPOOL: YES SOPUC Tank: NO
NA ruRE OF SERVICE: Kou:rIN F;MEROENCY
OBSERVATIONS:
GOOD CONDITION ....... To COVER DEC 0 7 2004
HEAVYOREASE BAFFLES IN PLACE.ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLD V� FLOODED
SOLID CAKRYOVER9'�'F
OTHER EXPLAIN
Syiitvm Pumpod by
�'UMMHNTS.
f-KANSYbi(KED I -L)
m
t
14�
r�
FORM U - LOT RELEASE FORM
r
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*************i`*********
APPLICANT AtIPAI Sa7lel'/',ri /7- PHONE 2y-2-� 7e
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION i LOT (S)
STREET ���" ST. NUMBER as�
OFFICIAL USE ONLY*�******************' "
RECOMMENDATIONS OF TOWN AGENTS: i0 ` q �� IOD �� giwa
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER
COMMENTS
DATE APPROVED
DATE REJECTED_
FOOD INSP TOR -HEALTH DATE APPROVED
DATE REJECTED
l
i
SEPT}C IN CTOR-HEAL H DATE APPROVED Z Z 7 civ
DATE REJECTED
COMMENTS r �-►�-�Cra��'�� -�-r� spa l�z tS:�Z� sc.07�c .ref ?` cont-- 7���
41. Lle
L `
SX .S
PUBLIC WORKS - S/EWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
Imp?_
tip
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7- We) if
lopl!i
, , f
MV, ovi
oll
0011 2?0P4r .4
5TiO4
.t. 'jop
FORM - U - LOT RELEASE FORM
�;. INSTRUCTIONS- This form is used to verify that all -necessary approval /permits from
Boards ,and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
Ammo..........■......................■t......WHEN noses ................ was .0
APPLICANT T �iy �� �' � a
PHONE vD
� �G z
ASSESSORS MAP NUMBER LOTNUMBER
SUBDIVISION LOT NUMBER
,J7� S
STREET STREET NUMBER �� 5_ (Y
...............,...........•
OF'FIC IAL USE ONLY .......................... .
o ............................. .............................. .............
ItkCOMAffi-NDATIONS OF TOWN AGENTS
I imp
C, DATE APPROVED r
CONS NATION ADMINISTRATOR
DATE REJECTED
TOWN PLANNER
COMMENTS
FOOD INSPECTO - HEALTH
SE SPE -HEALTH
i'
rnr n� fF1.TT R Y . i�/��l I �• LP C /
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
COMMENTS
RECEIVED BY BUILDING INSPECTOR
DATE APPROVED
DATE REJECTED
DATE APPROVED
M ft 0 RM:CO-1 C
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
"z>
E P E E
FEB 1 F 2001
BUILDING DEPT
Commonwealth Engineering Associates, Inc.
MORTGAGE SURVEY
This certification on this plan is made for mortgage purposes only. The undersigned will not be responsible
if this plan is used for boundaries, fences, plantings, special permits or variances.
WF J b d REALTY TRUST
J
146.71 r �
LOT 5
A 258029 S.f•.. ip
l /
V -
4 NO. 258
�® I STY. WOOD
LOT � o
m
M'
�O
LOT 6
s�\
125.00
REA STREET
► 0 ( Location NORTH ANDOVER,--MA.--
&
NDOVER,MA_& Date . 7- 2 - 1966 Scale: 1 inch - 40 feet
RMUOM
No. 31342
lip
o'�a Deed and Plan Reference:
��'�1t 11►No Dead Book 2_ 8_ Page 6 9 2 Plan Book 7 2 4 3 Page —
/5 17 a of — .-- - - L _ __L. __—J_ —
--NNW
a.
Property Address:
Owner:
Date of Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
�v .ate �i �� �►
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' ((� 1
DEPTH TO GROUNDWATER
)� To L _., !. J
/9 -/ o L -- r
�Zp_ r4/
30�
%3 Tv
Depth to groundwater: � k feet '
method of determination or approximation: �U �`" ``' G !7•-/
l'L._ 0 /_ SF k
4
(revised 8/15/95) 9
N ...1.,— -, �ryc4ea raper
Commonwealth .Engineering Associates, Inc.
MORTGAGE SURVEY
This certification on this plan is made for mortgage purposes only. The undersigned will not be responsible
if this plan is used for boundaries, fences, plantings, special permits or variances.
WF j REALTY TRUST
146.71' r
LOT 5
A = 25,029 s.f. '
." of
01 1M
RED OND
.. Na 32342
�o�♦ Aor��em�
�0 t twae�
NO. 258
3 I STY. WOOD
oe
v
m «
'0
10
STREET
12.5.00
LOT 6
C�
Location NORTH ANDOVER- MA.
®ate 7-2-1966 scale: 1 inch • 40 feet
Deed and Pian Reference: —
Deed Book 12.28 5 Page 69 2 Plan Book 7243 Page
FORM - U - LOT RELEASE FORM 31
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any. applicable requirements.
�aaaaaaaafaa■aaa'aa'faasaaar.raa■sa■aaaaa0aaraaaaaalloawaa'a.aa■aa 00aaa00:■a00aara■
APPLICANT /�/� 1a /L
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jf -')yam
ASSESSORS MAP NUMBER LOTNUMBER
SUBDIVISION LOT NUMBER
�� t r STREET NUMBER
SasTi::Tsa'a'ra.sssassaasrsaaar.ars.■.Asa.saaasa.■sa�asa�ra.asasaaasrsrasaaas.arsaAsa■
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RECO ATIONS OF TOWN AGENTS
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DATE APPROVED : A/
CONSERVATION TRATO
DATE REJECTED .
COMMENTS
DATE APPROVED
TOWN PLANNER DATE REJECTED
r�nr�[nrtFT3'i'C
DATE APPROVED
FOOD INSPECTOR - HEALTH DATE REJECTED
21 DATE APPROVED
SE m C INSPECTOR - HEALTH
DATE REJECTED
CQAQvIENTs�4-e
PUBLIC WORDS — SEWER ! WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMNIEN'TS
RECEIVED BY BUILDING INSPECTOR
J
TOWN OFNO$.TH ANDOVER r
SYSTEM KWING RECORD
DATE/40 v 13 26a3
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
.. Safer�al�
Alo rY-h aAldo ve r
DATE OF PUMPING ��'' `0 3 QUANTITY PUMPED r�y
CESSPOOL NO YDS SEPTIC TANK NO YES
NATURE OF SERVICE: ROUTINEL----EMERGENCY
OBSERVATIONS:
GOOD CONDITION &, FULL TO COVER
HEAVY GREASE BAFFLES IN LACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER OTHER EXPLAIN
SYSTEM PUMPED BY /l' f &' (�
r
COMMENTS:
CONTENTS TRANSFERRED TO '
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: l a i b )
SYSTEM OWNER & ADDRESS
)i r so,ter i o.vj
SYSTEM LOCATION
(example: left front of house)
S t .
DATE OF PUMPING: I 6 QUANTITY PUMPED CD GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY: DAG
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
b
c JcI- vi ce , Ty, C,.
COMMENTS:
CONTENTS TRANSFERRED TO: CN', k-.cc.wcemce- �� A„;
11
t^U 2010
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Date of Pumping: 1012kI9l 6
Commonwealth of luassachusetts
Massachusetts
System Pump en Ree - -rd
Cesspool: No ❑/ Yes. ❑
Quantity Pumped: /006 gallons
Septic Tank: To ❑ Yes a
RAGGS SEPTIC SERVICE, INC.
System Pumped by: d.b.a. E. A. COMEAU SEPTIC License r: -
Contents transferred to: WATER SOLUTIONS GROUP, TAUNTON
Date to 2L AInspector
RAGGS SEPTIC SERVICE, INC.
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