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RECEIVED
Commonwealth of Massachusetts MAY 14 2013
1,
City/Town of TOWN OF NORTH ANDOVER
System Pumping Record NORTH AND
Form 4
DEP has provided this form fqr 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 Nov+� Andovc,(
State
City/Town
2. System Owner:
Name
nt j�oir�, loc�ai�jn
-�ddr��s (((�A�-�e
0)
Zip Code
State Zip Code
di—yffown
Telephone Number
B. Pumping Record
1. Date of Pumping Date* 2, Quantity Pumpedi Gallons
3, Type of system: Cesspool(s) Lj&'Septic3ank Tight Tank El Grease Trap
[D Other (describe)�
4. Effluent Tee Filter present? Yes L��No
If yes, was it cleaned? [] Yes [0"No
5. Condition of System:
- -- - --oy-u-CAl-'a 5- 4�(Ie-
6. System Pumped By:
vehicle License Number
Name -Ef I \ ,
Company
7. Location where contents were disposed'.
G, D.
Ls
of Hauler North Andover. M A
-�,7paTu-,e �f—R-e-ce-7tvjng Facility
Date
Date
i5fGcm4.doc- 03106 System Pumping Record - Page I of I
Ftem Owner
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Type: Em
Cesspool: Klo
bate of Pumping:_
System Pumped By:
Contents transferred to:
Contents Disposed at:
Form 4 -- System Pumping Record
Commonwealth of Massachusetss
- Massachusetts
System Pumving Record
Routine
Yes
Location
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Septic tank: Klo OYes E�
Qua" Pumped: �So-% Gallons
Wind River Enw"mittal, UC Permit #:
Date: D I Pumper
Condition of System/Other Comments
Water
Dep Appmved Prom - 12107195
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FORM U.- LOT RELEASE FORM (6 -C;?o -00 0
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.
P LI CANT FILLS OUT THIS SECTION
� —
PHONE
APPLICANT
LOCATION: Assessor's Map Number 12 PARCEL
SUBDIVISION ------- LOT (S)—=—_- ----------
STREET �QS ST. NUMBER
USE
RECOMMENDATIONq OF TOWN AGENTS:
=]�Ilv Le - 1
CONSERVATION ADMINISTRATOR DATE APPROV D i
DATE REJECTED -
COMMENTS
14-
,
V
TOWN PLANNER
COMME
FOOD INSPECTOR -HEALTH
§k�TTCC IN§PECTOR-HEALTH
5 "s I IT,
DATE APPROVED
DATE REJECTED—
DATE APPROVED
DATE REJECTED -
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 jM
DATE
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FORM 4 - SYSTEM PUNTING RECORD
SEPTIC & DRAM'SERVICE
�107 FOREST STREET; hop MA 01949
(978)374-2772"�
4-�
COMMONWEALTH OF MASSACHUSET-rs
MASSACHUSETTS
S YS TEM P UMPING RE CORD
SYSTEM OVINER: A"' SYSTEM LOCATION:
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j5fom G,)oc1,)t,1
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DATE OF PUMPING� 9 9
QUANTITY PUMPED: GALLONS
CESSPOOL: NO, YES
'4' SEPTIC TANK: NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: LZ D
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DATE:
INSPECTOR:— e5��
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Town of North Andover, Massachusetts Form No. 3
,joRTh BOARD OF HEALTH
-19
DISPOSAL WORKS CONSTRUCTION PERMIT
emus
F% ry\
Applicant
NAME ADDRESS TELEPHONE
Site Location --)- 71 n 'S S
Permission is hereby granted to Construct or Repair an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee D. W.C. No. - A,
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William -Whitcomb
Boston
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEAITH DEPARTMNT --NORTH ANDOVER,, MASS,
I hereby make application for a permit for a sewage disposal installation at
Bostbn St* 0 1 will install this system in
accordance with all the laws of the Commonwealth of Massachusetts and regulations
of the Board of Health of the Town of North Andover.
Furtherp I wi" construct the house sewer of bell and spigot pipej the minimum
diameter being,4 inches, and will maintain a minimum grade of Va until 10 feet
preceding the septic tankp where the grade shall not exceed 2%. 1 will install a
concrete septic tarAt of 600 gal*_ in size. A manhole (s) permitting easy
cleaning will be provided with removable cover (s) of iron or concrete within 32
inches of the ground surface, I will provide subsurface disposal field with open
jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a
series of trenches, the bottom of which will provide a minimum of 200 lineal
(29ffin) feet of effective absorption area. The pipes will be laid on a 6 inch
layer of washed gravel or crushed stone ranging in size from 3A to 1-1/2 inches
(dia,) and the pipes will be surrounded by similar material to a height of 2 inches
above the crown of the pipe, The joints of these pipes will be protected from
clogging and before filling the trencho 2 inches of gravel or stone 1/811 to 1/1+11
(dia.) will be placed over the course gravel or stone. The disposal field wi" be
installed at a grade of A+ to 6 inches/iOO feet. No single tile line will exceed
100 feet in length and in any case, two lines of tile wi;1 be installed. A minimum
of 6 feet will be maintained between the center lines of the disposal field trenches
and the average depth of trench shall not exceed 36 inches. Nopart of the in-
stallation will be less than 100 feet from any private water supply.. 25 feet from
any stream, 20 feet from any dwelling or 10 feet from any property line. I further
gfficer uirements that
. __,, as provided below$, and to incorporate any additional req
may be attached to the permit. Plot Plans must be submitted with application,
DATE April l6s 1957
Signature of Applic"a'nl
I hereby issue the above permit for the Board of Health of the Town of North
Andover# fibsoachusetts.
DATE Uril 16. 1951
'Signi of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE
Signature of Inspecting Officer
7
Percolation Test 2
Garbage Grinder .::�
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April 16, 1957
Miss Mary Sheridan R.N.
Health Agent
Board of Health
North Andover, Massachusetts
Dear Miss Sheridan:
An examination was made relative to the
suitability of the soil for the sub -surface dis-
posal of sewage on the proposed Boston Street
building site of Mr. William Whitcomb.
The soil in the area consisted of sand,
and a percolation test of'3 minutes and fifteen
seconds was made.
It is recommended that a 600 gallon septic
tank together with 200 lineal feet of drain pipe be
installed. The width of the trenches to be two feet
and the nearest portion of the proposed drain field
should be 100 lineal feet away from his well.
Very truly yours,
Ernest F. Romano
41
1.
20
04
BOARD OF HEAITH loo
TOWN OF NORTH ANDOVERl MASS.
Wx=
NAM DATE...
ADDRESS . . . . . . . LOT NO . . . . . . . . TEL . . . . . .
3. NO. OF BEDROODIS DEN YES NO.
GARBAGE GRINDER YES NO.
SHOW DIIDENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES-4--p-,,&,�*-e--7
4,L�
7. SHOW DIlvENSIONS OF LOT
8, SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9* NOTE LOCATION AIM DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHGW LOCATION OF BROOKS9 STREAYSO DITCHES., LEDGE OUTCROPt ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOYE: LOCAL REGULATIOVS SHOULD BE READ CAREFULLY.
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BOARD OF HEALTH
TORN OF'NOFTH AIWOVERt MASS.
I# govwlv 5'r.
. . . . . . DATE
1, NAME
10T
2. ADDRESS NO* TELP
DEN YW
3. NO, OF BEDROOIZ
GARBAGE GRINDER YES 0 * a Noek 0 0 0
5. SHOW DIT-AENSIONS OF HOUS9 0� -11( x 3- y
6. SHUR DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIIENSIONS OF LOT
8. SHOW LOCATION AM SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF wELL FRoTa smaum SYSTEM
10.
SHOW LOCATION
CP BROOKS, STREA1,13, DITCHES$ LEDGE OUTCROP,
ETC.
11,
SHOW DISTANCE
OF SEPTIC TANK OR CESSPOOL FROM HOUSE �O
r,64 -7 -
NOTE: LOCAL REGULATIONS SHOUID BE -READ CAREFUILY.
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