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" ", - 4 ) -.4 � � I I' ..�: r .' , , . . , r. - I I . � , ,-, ,plm r _ � r ' -;i , � -, �, 4 i' � , r - - , & - , - . ,. "'i; '. 1 ,4.. , . _ 't,� . , '. , - . '. 11, r ,,,k. � lr�' I �i, L I - �� I *,?' 1. r ,q - Irt I - � I � r� � . � . r 1: I I 1, �� , % , .11 I , %`� , I . : , . , � _ - . , air " tl ' i "�_--` I . . �,, 1, I " 11 " , - , ,�, . . . � ; ., 1, �� , _ - I , , . , . . , . , � , . A . , L �l � I ,� . , r , I -, � . , j , 1, 1. .ul�: '., , , � ,� _,'� .1 , " I , I - I ;;" I ,q ,,, : k . '. - . - . � , . �, If—\ Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record PNOV 30'N11 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other forms OAaWjE3ffj&':NT 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 / Right front of house, Left / Right rear of house, Left Left Right side of building, Left / Right front of building, Left / Right rear of building, Under deck 2 Address L Cityrrown State Zip Code System Owner: Name Address (it aitterent trom location) City,rrown B. Pumping Record 1. Date of Pumping 3. Type of system: F1 Date Cesspool(s) State6 <iNa Telephone Number 2. Quanu Pumped 0--S—eptic Tank Gallons El Tight Tank M Other (describe): 4. Effluent Tee Filter present? Ej Yes No If yes, was it cleaned? El Yes F1 No 5. Condit* fS t 6. System Pumped By: Neil Bateson Name Bateson EnteMrises Inc Company 7. Lo contents were disposed: Lowell Waste Water =-...L S F5821 Vehicle License Number tt- ir?-I( Date t5form4.doc- 06103 System Pumping Record - Page 1 of 1 AN- . N . Commonwealth of Massachusetts R. City/Town of RECEIVED sys*tem Pumping- Record Z014 Form 4 r M.N u I e AN= -ER DEP has provided this forr n for usez by local Boards of Health. Other information must be substantially the same as that pmvided 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/ Right front of house, 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 dwrown 2. System Owner Name Address (if diftrent from locafion) Gdyrrown B. Pumping Record 1. Date of Pumping 3. Type -of system, - 4. S�- state BL)--�- �-e� Zip Code stile Code Telephone Number 2. Quan Date ��.Pumped: Ga loi PUc Ta Cesspool(s) pfic Tank El Tight Tank Other (describe): Effluent Tee Filter present? Yes 0-19�0 If yes, was ft cleaned? 5. Condition 6. System Pumped By. Nell. Bateson Name Bateson Enterprises Inc - Company 7. Locafi_*on-whfM contents were disposed: Lowell Waste Water El Yes El No k (e & j -'a" � j F5821 Vehicle Uoense Number .1 Data t5fbrm4.doo- 06M System Pumping Record - Page I of I ,C\ C ommonwealth of Massachusetts City/Town of Sys*tem Pumping Record Form 4 DEP has provided this form for use-- by local Boards o f 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 forrh 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/ Right front of house, Left/ Right rear of house, Left. !%-ht side of Left/ Right side of building, Left Right front of building, Left / Right rear of buildii � �ngt �sideof hou e ng, n er ec Address '�� /9 <::� L� Cityrrown State Zip Code 2. System Owner Name Address (if dffjrent47,1p�o6tn ii Cityrrown NOV 9 N13 e 81n�D- 6001 Telephone Number TOWN OF NORTH ANDOVER HEALTH DEPARTMENT B. Pumping Record 1. Date of Pumping 3. Type of system- E] 4. 5. 0 Other (describe): Date Quantity Pumped: Gallons Cesspool(s) 15--SePfic Tank El Tight Tank Effluent Tee Filter present? E] Yes RIN o If yes, was it cleaned? 0 Yes M No 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc - Company 7. Location where contents- were disposed: Ja -Q Lowell Waste Water [t —67— Date t5form4.doc- 06103 System Pumping Record - Page I of I Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record NOV 2 5 2008 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of H. ed, 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, left rear, left side of house. Right front, right re<,:r:ig:h]t! e of �house Address (-'\ /- Cityrrown State 2. System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: 0 Other (describe): Zip Code State -',,��ode R`7 Telephone Number t ( -7--<fZ Date 2. Quantity Pumped Cesspool(s) a-Te-p-t-ic Tank Gallons F1 Tight Tank 4. Effluent Tee Filter present? M Yes P--11�0 If yes, was it cleaned? [I Yes F1 No 5. Condition of System: YJ e�97��k� 6. System Pumped By: Neil Bateson Name Bateson EnterDrises Inc Company 7. Loc ' here contents were disposed: � rQ�. S. �D Lowell Waste Water of F 5821 Vehicle License Number Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 4"\ Commonwealth of Massachusetts VCity/Town of System Pumping Record .J� 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 - VQ DEP has provided this form for use by local Boards of Health. Oth information must be substantially the same as that provided here. local Board of Health to determine the form they use. The System the local Board of Health or other approving authority. A. Facility Information 1 - System U � Z�A <Dz�-'e Address Cityfrown State 2. System Owner: Address (if different from location) SEP 14 2007 forms may be used, but t e c' with your jm�i�64-R td,must-66sibmittedto Zip Code City/Town StatVj Zj Code Telephone Number B. Pumping Record ( 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: 13 [I Other (describe): Cesspool(s) Q-aig-ptic Tank E] Tight Tank 4. Effluent Tee Filter present? El Yes 12- �o If yes, was it cleaned? El Yes n No 5. Condition of System: V\O� \A-11� t � e--Aj 2 ' S y s t e P rn p ",edBy: Y' :Name Vehicle License Number Company 7. Location Signature ce contents were orsjVs, Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Conguonw9alth of Massachusetts VWj'-6-e)a-O- �,Massachusetts System Pumping Record System Owtier ; �) +U,<— Date of flumping: 9 , rcl)-6 — 9 ? Cesspool: No L. -I System Location 9A - QuafitityPumped: 't6-'�-�gallolls SepticTank: No Yes System Pumped by: Faredart go&v�ftaa License # Conten(sttansreurredto: Greater Lawrence Sanitary District Date: Inspector- RTH 0111 - RD ' -.,/ la� 25� r1w, 0, + W/f imp 'elk ev-w �:- � -,Oc fV** � 34',l 1,4�'l Ls -2 (a - - - - . . ?. -:!5� , - Tee W60 ( U. T. -5. cr 2 - LA ILP 7- 172 Pi we �11 14Y 17 lit" Ho W-ft-rz, eq T Cy, wr. 1q, �Frpv,� fl 146 $ivry ldlovcw JK41 100.00 ISO' �v, pr5r, :-- I *�;),< 1, - 7,1 rr kirls-, . 0 & u, Clef 09 5IC4, /4 0 naa zoamcwi ce Tln,�,lae,5 1, OAL.J, i3e AFviz---4a-iA-TP-LX 7 Fr POW,4 PdoH Illf- 6le->UQ[2 4Llfhi4,e AT -r3l. ve - 'ZI 6� r -T- 0. C-) navoebrrcp elm 15;�Lk, i39 1�,LOf`60 5)"5000 rift 9: 15 -,,Lore 9 61 I5,owc, mpg rwri 0ougas vjor Lo-, 'rl" 7 -, �J. cnap op nfs;Is -'Wo,La, A-t,ltl V10141 --D. �. '30uTL&,r re - sow. &A -L r—'-- All jw;Z cy I C7-1� -r-z;` i5-4-V:PLrz, (p IOLST TO -'rj%vAV.) ,too J c H 0 ri S U BE -3 U R FA C E D I IS POSAL SYSTEM LOCATEDIN -A, AS PREPARED FOR H I e., 1.4,6, s L, 1;3 u -r Ligi p - DATE: ze?, jr-jq,� SCALE: III.- 4o' "' c2ev i,�,e p eo'10-93, 0av '5IL"HA� -f- TV-AV9,eT5I ' MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 Gr TEL (617) 475-3533, 373-5721 3 zl�4dsml J -r 41 TONVNOF SYSTEM PUMPING RECORD DATE: 19 -Cz� - 03 SYSTEM OWNER & ADDRESS �'64 �061'so& SYSTEM LOCATION (example: left front of house) �'A � ac� 0 DATEOFPUMPING: j-,23-03 QUANTITYPUMPED: CESSPOOL: NO YES SEPTIC TANK: NO NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER 1-1 Zo, 2Z'-�:- 6vsc GALLONS YES /_ FULL TO COVER BAFFLES IN PLACE LEACIIFIELD RUNBACK FLOODED OTIHER (EXPLAIN) sysTEm PuwED BY: Bateson Enterprises, Inc. COMAIENTS: CONTENTS TRANSFERRED TO: r, L h 91 2 Le -r m r 6, -- I,qp, -, �- 7r-L E �A" L_ Ff L't, ";�ZT —U+ 3 TZ 1-15 51 4y WO 0-6fU44t, .. . "Q la $Ivry �F-"o ezl� 00 e e fu�&L' U. T. 6. 41.1 , " . /� t' W/FirTer- rwu� oyse +1 L- orr z 1p 172 "il 101 wr. 101. 1 JOH 0 470 �j F bb, �j 0 � ri too -0 0 e� G, --F :- -2 :�- 7,1 irr. z')0'rr0Vj ci: Afrize-Aa-wTEL,Y 7 Fr 901-114 P`2-1-1 -Toe '�LIIEPACA Xr TV'6"C'405 g s rV24W 1 t7. w I Ve -, Tl (-l' L. 0'..' 61 �-T- 0. C") merou'rco VIM 10 'Tlze0w&� /* w rew-r-i 'T'^0- 4;L'Ore'a' tct� Wof L65--, SIA-1�4 pe", At-' 1 &0 ,,�. -s -ror4 u, L (0q s ewL? or - 4"t, '300TI. Etl- 1 13 0)c. W 6AL 14LST TO too SUBS'URFACE DISPOS'AL SYSTEM LOCATED IN ki 0 2-T 0 bl' 1Q, POVe;Z, AS PREPARED FOR H I , t,4 b, s L, e u -r u�� 12. DATE: Z b t I c2ey i47e P SCALE: I It --40' V�rt'l' :. !&-) - e's '�ercl�wy-" r- zi t> 8 7"q 41 mok& 15 40,pz- TOWN OF NORTH ANDOVER Approved Date la'3 /9-5 Signature eo, to 5t 0 O -V MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 41� TEL (611) 475-3553. 373-5721 2 CLCA" L�qTz ? Tv -6w(,0 U, T. '5. pi 1:�i 14y 5&wo 11,2 Fl W6 51,;Ty �P,"o TZ Cc., -2-7,115) Ho W&rtv, WO 0-04�At, 3(0-" 1137-" 00 t-wreg" 00 IZ 9 fu56L. .fv("r. rlol�h (�,Qovp, vlo - 34-', 1-1&64 ra p Z-)oamv" cF ,&fpZc>w-IA,-MuY 7rr VOW-! Paorl -TOe ent.-woo '�Lif-444A Ar 'f3l. ;,)*Two—lv,6wcAet, ';s rew1o. (s fy. wivet SAO('*, 4`11T. o.c") f-,,oFottrfeq i7irs - 5.111�000 rift 5 15 e, tor e o (ti 7,AsAv-- ro OOU9-� 1 e,"A,LA.,o 15e: ej�orelcp 0,� L65--, *rAA.4 evip or- ,$QA,t.0 A."t, vtoww-0. JOH 0 '--�o 0 IWO eaAL - Fbb, d 0� 2 e PL, 6, �,, e ri -, �-17 U SUBSURFACE DISPOSAL SYSTEM LOCATEDIN kloV-T0 AS PREPARED FOR H 16, S L, V:) w -r u� �L DATE: zbt jcjq,� SCALE: I 4c), MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LANDSURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER. MASSACHUSETTS 01810 6� TEL (617) 475-3M3. 3M5721 w I : I 1 /7er! 4-11 2 71 it zo, iz zv, 6wo T Z. Ll 1 51, - e.051 . % An I %, � -r. e.01 -i IV 511 1 /7er! AS BUILT PLAN.,' OF �—D Suc0hc-j%URH-A'a(';'kE DISPOSAL SYSTEM ,LOCATED IN 00e:TI-1 AS PREPARED FOR L, 6u-rL F, c, DATE: ti I SCALE: '1 40 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0' LAND SURVEYORS 0 PLANNERS PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 Or TEL (617) 475-3553, 3M5nl & Ilk .11500 .5 V 1-4E LL I 'A' F Oki 45>0 Z2 -T v AS BUILT PLAN.,' OF �—D Suc0hc-j%URH-A'a(';'kE DISPOSAL SYSTEM ,LOCATED IN 00e:TI-1 AS PREPARED FOR L, 6u-rL F, c, DATE: ti I SCALE: '1 40 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0' LAND SURVEYORS 0 PLANNERS PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 Or TEL (617) 475-3553, 3M5nl FORM U - IOT REIEASE 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***************** /APPLICANT: 010:5. kL*v-_-7_ rR>,,_,,,. -Phone 6Bz—,6cDE37 _'10�1�CATION: Assessor's Map Number Parcel Subdivision k4treet OZ4- S79_!E71__T_ Lot (s) St. Number ************************official Use only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments �Y, " - C, 4-f L,)v A ',,c-,eC1v 5 - b 5 Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date r0), BOARD OF HEALTH 120 MAN STREET NORTH ANDOVER, MASS. 01845 Merrimack Engineering Services 66 Park Street Andover, MA 01810 RE: 264 Johnson Street Dear Bill: TEL. 682-6483 Ext. 32 June 2, 1993 I received the revised plan for the repair at 264 Johnson Street and would like some additional information on the plan. 1) Existing and final topography with elevations 2) Slope shown in the y/x formula 3) Elevations of the bottom of the trenches, d -box inverts, septic tank and building sewer If you have any questions and wish to discuss anyt hing with me, I suggest you call the office as close to 8:30 A.M. as possible. Thanks. Sincerely, Sandy Starr 2 CLE A. 0 rl LL, Covg�t ti 0-fe 'fvrj'- r1oli'll 612Ave/ Z7ae-u- 09 L�Owlcp t' 4ezmv rA v Lerz 1-1 .5 3(o, I�i 14y W V40 T'� t;, I - " fl"d- 113V 0" ".WTcg" 00 e e fu�a- U. T, 6. 1+1 L- crr +I 1,147 AC-) 1�w 4 ey, wr. I �-k Flo. 0 g (A'4 1 r--- I I so, m orf F, s . & 1,1. (71 ;7f -5, 0 rV C. OcrrtH C,� S�PALJ' E36 Afp,ac>4i�-wTEL,Y 7 rf' VOW�4 Pa& -1 -Tile die,.?uIjc? 4LIf-hVfe #6"r -r3l. ;,)-Two —%vl6wc-"lg5 rl?'W10. (s I`- wlcv, -40("r� 4,19T. ac") marourep Firs 1;'�LL' i�e 'tpl'OF60 47r -'5 OL 10 rl n F teom n 3r. i;ooc 'To TA'tj W Z -ow p f COH Z'L'oretp 5Irr Lo-, 'roA.-I pp -414 Feee, , .oe; IS, U, - 1-7 -2 '1, F Z. I (,7c> res? Fz '30UTLerr (7v-p,rr- . PSOIC. W eaAL. j 0 H LZ' 2 e PL, e rl 61 U SUOLK-3URFACE DISPOSAL SYSTEM LOCATEDIN AS PREPARED FOR Hlc,�4 AtI, s L, t;3 u -r L.;�ijz DATE: Ze?j jcjq-� SCALE: 40, #- ;Z 6 4 -jo q1V �W A/ 'S 7-, MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER. MASSACHUSETTS 01810 or TEL (617 475-3553. 3M5721 LeT 1,9 7 ISO' T1 3(oo 14y 11 2 �l 1-46 �lvry 6p,"o 61.eAo F1 I' L, CoVg;�r " 0-1le- TZ (cv--Z-7,90 132�` 00 V-wreq,* "o e e k6AL- -T"y P Tv-swal ( u, -r. --,. ) ,&rpza4a-iA-TEL,y 7 rr PoWo4 PQ-rl -TOe ene,-.IUQV '�W?hVA 'r3l. ;,)-Two –lv,6wc+le5 �,Jo— (.5 fy. wImg -io(-C� L-oi.-Ien v Fce-rouc"L? Pin 5d -,r vv -v L&-� Z.6% LAS 0 v voeoo.. z-2 0 -ra,r4, L. &^ I� . , (,,7c> p Pi r64; GIT 600wee'rep '317 lJT L Er . %cp)c. P. I W dIAL - r,v-- TA*A I::. ri SUBSURFACE DISPOSAL SYSTEM LOCATEDIN kll�,V-To 161KIPOVe�a, AS PREPARED FOR H 16,0 b, F, L. e Lrr u::� P - DATE: z1b, SCALE: 40, MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER. MASSACHUSETTS 01810 07 TEL (617) 475-3553, 3M5721 ,:9,64 J61,11VS61t) 7-6 10e /S 7-1 IAI --&07,7e-1V , /L4T Z [ I -47'c. 4y- t -16.p I': zoo' 1L 00 00 JoJ R'b'o op 00TE'e?: 461.1 rfe lA&u' ge, '�e4- 40 pv& V�vrroH rr� --roeqcget' "'q&L4, 13p, A FF eox. 4e �elrl Aevl.40 jl4er&r-F- 3,)-rwo 'Ta6we-l-w5 ti4mw' 0& f"vic), (Ist fr S WIM Oy 40 L406% V611 -r- o'e..) 4.�'Tpu* -5A&LL* 0a Ai, 5r&olp, -'2' T 02 E el T � U 01"URFACE DISPOSAL SYSTEM 'D LOCATEDIN 00.0 -TO 1. b\ W P 0yr, �z AS PREPARED FOR DATE: HAY 7, 1194 It - SCALE:l MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 Or TEL 1617) 475-3553, 3M5721 a6A 0 p I L'L' 40; WlOvra FA W Y-'-'rT 5- -'2' T 02 E el T � U 01"URFACE DISPOSAL SYSTEM 'D LOCATEDIN 00.0 -TO 1. b\ W P 0yr, �z AS PREPARED FOR DATE: HAY 7, 1194 It - SCALE:l MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 Or TEL 1617) 475-3553, 3M5721 4 ,. i — I - i d �r d, j '� r �.� - r a i rf i t j' �Li WATERSHED RESIDENTS QUESTIONNAIRE 1. Name Ile 2. Street Address C, 3. How many members are in your household? A�. 4. What type of sewage disposal system do you have? cesspool septic tank and leaching area El connection to municipal sewer El other (describe) El do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? 0 yes El no [�J do not know 6. How old is your sewage disposal system? 0 0-5 years El 6-10 years El 11-20 years 91 over 20 years 0 do not know 7. Has your sewage disposal system been rebuilt or repaired? 0 yes R1 no El do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? El annually every 2-4 years El every 5-10 yearc, El over 10 years never 9. Have you had any problems with your sewage disposal system.? K yes El no If yes, what problems? 0 repeated pump -outs needed Q system clogs, backs up, or drains slowly R1 odors El sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher r* -Sccdd- clotheswasherm*vnr2iy,�C, 12. Does your property have a lawn? yes no If yes, approximately what size? El less than 1/4 acre 16 1/4 acre El 1/2acre El 3/4 acre acre El more than 1 acre (Specify) - acres 13. How often do you fertilize your lawn' 1% " 6 No. of applications per year Iwo J�106 - 1-01 Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: E c dis G ni i lor El Check here if your lawn is maintained by a professional landscape contractor. SEPTIC SYSTEM INSPECTION FORM ADDRESS (0 �6 DATE INSPECTED PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS: WATIER aVALITy TESTIEt,"Z RESOL-T-S� DYE TEST PERFORMED? Y N DATE? SKETCH: C WATERSHED RESIDENTS QUESTIONNAIRE 1. Name C 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? Ej cesspool 0� septic tank and leaching area n connection to municipal sewer El other (describe) F] do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? El yes El no [vJ do not know 6. How old is your sewage disposal system? 1- 1 0-5 years [A 6-10years Ll 11-20years [� over 20 years F-1 do not know 7. Has your sewage disposal system been rebuilt or repaired? El yes [� no F-1 do not know If yes, approximately how long ago? years. What was done? 8. H w frequently is your sewage disposal system pumped out? - L-1 annually every 2-4 years F-1 every 5-10 years over 10 years never 9. Have you had any problems, with your sewage disposal system? i!� yes F1 no If yes, what problems? repeated pump -outs needed system clogs, backs up, or drains slowly 91 odors 0 sewage surfaces through ground 10. How many of each appliance ar e connected to your sewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump punip toilet roof/pavement drains shower/bathtub 11. Please state the - brand and type (liquid or powder) of detergent you use for: dishwasher c c,� ' - '-- clotheswasher nc, r-rN C, 12. Does your property have a lawn? M yes El no If yes, approximately what size? El less than 1/4 acre [A 1/4 acre Ll 1/2 acre [J -/4 acre 0 acre El more than 1 acre (Specify) - acres 13 How often do you fertilize your lawn" No. of applications per year -le-00 j Season(s) of tl�e year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: I /Of El Check here if your lawn is maintained by a professional landscape coniractor N Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner System Location BU DO Date of Pumping: 0(— Qua�tity Pumped: Cd>�gallons Cesspool: No Yes Sep tic Tank, No El' Yes e�T System Pumped by: 641!�4" License # Contents transfertred to Or -eater Lawrence BanlLary District Datei Inspector, Commonwealth of Massachu City/Town of System Pumping Record RECEIVED DEC 2 3 Z009 Form 4 LTOIWN OF NORTH ANDOVERJ 0 The T 0 P TMNT LT HEALTH DEPAR _ N 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. S ti n: Left side of house, Right side of house, Left front of house, Right front of house, eft maLgf house) Right r�arpf house. Left rear of building. Right rear of building. Address City/Town 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: El El Other (describe): State Zip Code State Zip Code Telephone Number 2. Quantity Pumped: Date Gallons Cesspool(s) a/Septic Tank Tight Tank 4. Effluent Tee Filter present? [] Yes 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: of t5form4.doc- 06/03 No If yes, was it cleaned? [I Yes E] No Lowell Waste Water F5821 Vehicle License Number —I a o'� Date System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts City/Town'of RECEIV System Pumping Record Form 4 NOV 10 2010 DEP has provided this form for use by local Boards of Health. Other forrdM90 1pj Ab QWR Ih ,t3 =4MMM information must be substantially the same as that provided here. Befor- 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 house, right front of house, left side of hou<, rd ht '3ide of house Left I a. rear of house, right rear of house, left side of building, right rear of building,' uj Cityf'rown State Zip Code 2. System Owner: Name Address (if different from location) City/Town state,,') ip Code Telephone Number B. Pumping Record L C— 9— (o 1. Date of Pumping Date 2. Quan i Pumped: ptic T 3. Type of system: Cesspool(s) eptic Tank [:1 Other (describe): Gallons El Tight Tank 4. Effluent Tee Filter present? R Yes If yes, was it cleaned? E] Yes E] No 5. Condition of System 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Loc contents were disposed: C /-rGL. Si. D-,- low,41 Waste Aef, Signature t5form4.doc- 06/03 Date (-C� -10 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts RECEIVE -0 City/Town of System Pumping Record OCT 26 201Z Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other orms may be used, but-inj 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 side of housk���, Left front of house, Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address City/Town 2. System Owner: state Zip Code Name Address (if different from location) Cityrrown State/') < Telephone Number B. Pumping Record I . Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: El Cesspool(s) [9,S—e—pt—ic Tank Tight Tank Other (describe): 4. Effluent Tee Filter present? [:] Yes FeKo� If yes, was it cleaned? El Yes [I No 5. Condition of System - 6. System Pumped By: Neil Bateson Name Bateson Entel-Drises Inc Company 7. �Loc 'Mere contents were disposed: LIS. L/f-, - j Lowell Waste Water of F5821 Vehicle License Number Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1