HomeMy WebLinkAboutMiscellaneous - 292 REA STREET 4/30/2018 (2)rr
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Commonwealth of Massachusetts
City/Town of
RECEIVED
S item Pumping, Record
YS
Form 4 JUN 0 8 2015
TOWN 4F NORTH ANDOVER
DEP has provided this form'for use.by local Boards 6f Health. Other forms rqqy _, *qw U
ph, Afthe
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 appmving authority.
A. Facility. Information
1. System Location: Left / Right front of house, Left 41 ht rear Left/ right side of house, Left/
1. Left;
Right side of building, Left / Right front of building, i:garh;treZar;o6f�buiIding, Under deck
MOMS
ra
Cityfrown
2. System Owner
Name'
Address (if different from location)
Cityfrown
B. Pumping
1. Date of Pumping
3. Type -of system
4.
�4 �eA
A
Date
Cesspool(s)
Other (describe):
Effluent Tee Filter present.? Ye
,s
5. Conditio of stem,
6-- System Pumped By:
Nell. Batesbn
Name
Bateson Enterprises Inc -
Company
7. Lo ere contents were disposed:
. =GLLS-i Lowell Waste We
State
Zip Code
State Code
Telephone Number
2. Quantity Pumped
B—S—eptic Tank
Gallons
Tight Tank
If yes, was It cleaned? n Yes F1 NQ
F5821
Vehicle Uoense Rumber---�
0
9
Date
t5form4.doo- 06/03 syslarn Pumping Record - Page 1 of 1
If
Commonwealth of Massachusetts [R E"" �CE I �'E'D
City/Town of V
System Pumping Record 1_4 Y 20
11AY 2 0 2013
Form 4
NOR'M, AMMUM
DEP has provided this form for us& by local Boards of Health. OthgrfgQ-����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: Left / Right front of house, Left /dni Ehl rear�of �house eft / right side of house, Left
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address
Cityrrown State Zip Code
2. System Owner
Name
Address (if different from location)
Cityfrown
B. Pumping Record
State
Zip Code
5 -I's - �s -? -1
Telephone Number -
'l. Date of Pumping S-1 3- 13 2. Quantity Pumped: 10ob
Date Gallons
3. Type of. systern: El Cesspool(s) ��Septic Tank Tight Tank
n Other (describe):
4. Effluent Tee Filter present? E] Yes
5. Condition of System
6. System Pumped By:
Nell Bateson
Name
Bateson EnterDrises Inc
Company
No If yes, was it cleaned? F-1 Yes F-1 No
7. Lo re contents were disposed:
Lowell Waste Water
F5821
Vehicle License Number
Date S 13 1
t5form4.doc- 06/03 System Pumping Record - Page 1 of 1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 5: -.2a -0,�-
STEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
bacl�--
RfcL 15f -
DATE OF PUMPING: :5 -2OM2_QUANTITY PUMPED I no 6 GALLONS
CESSPOOL: NO YYES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE YEMERGENCY
OBStRVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
q2
SYSTEM PUMPED BY -
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO: �� - L � S , �S ,
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form.4
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. Befor usinqqhisif .,-.qec; h� your
ffa
local Board of Health to determine the form they use. The System Pum p g R eeAc' O""r ubmi L d to
the local Board of Health or other approving authority. zoli
A. Facility Information
1. System Location: Left front of house, right front of house, left side of
ear of house right rear of house, left side of building, right rear of bt
111 A�da
Cityrrown State
2. System Owner:
Name
Address (if different from location)
City/Town
TOWN OF NORTH ANDOVER
,underdeck.
Zip Code
State Zip Code
—
Telephone NuFnber
B. Pumping Record
1z' -
00b
1. Date of Pumping Date 2. Quantity Pumped: Gallons -
3. Type of system: El Cesspool(s) El Septic Tank El Tight Tank
0 Other (describe):
4. Effluent Tee'Filter present? 0 Yes EQ/No
5. Condition of System:
C)(VvAr,
6. System Pumped By:
Neil J. Bateson
Name
Bateson Enterprises Inc.
Company
7. Location where contents were disposed:
uler
If yes, was it cleaned? 0 Yes E] No
F5821
Vehicle License Number
ate
t5form4.doc- Q6/03 System Pumping Record - Page 1 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 APR 15 2009
System Pumping Record TOWN OF NOffH ANDOVER
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.
A. Facility Information
1. System Location: Left front, left rear, left side of house. Right fro Indight �ear, ri4t sid
Address
City/Town
2. System Owner:
Name
Address (if different from location)
City/Town
1U.
State
Zip Code
State Zip Code
9173-- 5_3��;?
Telephone Number
B. Pumping Record L(_,!�2_09
1. Date of Pumping . Date 2. Quantity Pumped
3. Type of system: U Cesspool(s) f �3—Sptic Tank
Gallons
Tight Tank
Lj Other (describe):
4. Effluent Tee Filter present? El Yes P_eo If yes, was it cleaned? Yes No
5. Condition of System -
M q C ZZ�a. [ CA_
6. System Pumped By:
Neil Bateson F 5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location_Mere contents were disposed:
tN
S. D t_e-� Lowell Waste Water
tignalu-re of H u r Date
t5form4.doc-.06/03 System Pumping Record - Page 1 of I
commonwealth of Massachusetts
City/Town of
SYstem Pumping Record
Form 4
SEP 14 2006
H NNDO�fER
I U�W_Vli�'DEP
DE.P has provided this form for use by local Boards I Her'MM.—T`he-S'Y–'s6m Pumping Record must
be submitted to the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out 1. System Locat—Jon-
forms on the
computer, use
only the tab key Address
to move your
cursor - do not
use the;retum Cityrrown
key.
System OWner:
Name
State
Zip Code
Address (i(different from location)
Cityrrown St
Z' bde
—A C
q7
Telep one Number
.13. Pum-pingRecord
I. Date of Pu mping
Date 2. Uu iti umped:
Gallons
3. Type of system: El cesspool(s) [a'S-eptic Tank El Tight Tank
El Other (describe):
No f
es I ves. was it cle
4. Effluent Toe Filter presient? E] Yes 0 If yes, was it cleaned? [I Yes F1 No
5. Cond t
6. Syste P ed By�
:Narne M., Vehicle License Number
Company
hftp://www.mass.
t5form4.doc- 003 System -P -Page I of I
:,umping Record
(,01,11nonwealtil of Massachusetts
&AJ_CjLv-, , Massacliusetts
System Owiter
VJZ-
Date of Pumping: V199hy
Cesspool: No Yes
ig Record
System Location
,j 9,� &, 'S �
Quahtity Pumped: 16M gallons
Septic Tank: No 1i Y e 9 P-1,
Systent Pumped by: FettC40d. F.;d&y�&W40 License
Contents tratisreured to : Giester L�wrencq Sanitary District
Date:
Inspector:
0
TO: NORTH ANDOVER, MASS kn-- 19
BOARD OF HEALTH
F ROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
453 7- 19,F4 '�5 71-- � North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19-
P)GALTY
WT b Vl�e A STgjG4;T
date: 1
OF
r
-7
)0,z
EYPIA,4iSI, 7 �7-
ALCA
4
4z,
wc
L
IC4.
ft-�e 4
\ e� 5p
v
joseph 1. barbagallo, mi3. I westward circle no. reading,mass.
CJ
SOIL COVIEV.
a" Mm.Top
YWA!)HeoPeA5T0r4E W- 3180
16"WASOED ClW SHED STOKE WLV4
5' 3e
ABSORPTION BED END SECTION
-T
Z6 A B-Sow,'PTIO ri AWE A=
ABSORPTION BED PLAN
OBS HOLE PERC HOLE
71
Li
Li
PERC RATE
GPEK TEST
TEST DATE
IT
t >
% 31
4m 4" &
A �- �o
IA
dr
Cl,
DISPOSAL
SYSTEM PROFILE
-T
Z6 A B-Sow,'PTIO ri AWE A=
ABSORPTION BED PLAN
OBS HOLE PERC HOLE
71
Li
Li
PERC RATE
GPEK TEST
TEST DATE
IT
Commonwealth of Massachusetts
iY, AY)do-,Ier -,Massachusetts
System Pumping Record
Systent 0 net -
Date of Pumping V /0()
Cesspool: No IV
System Location
-)- I -)l (��k 15�
Quantity Pumped
yes LI SepticTank: No
System Pumped by: verre-dart ge&n,64ijed License
Contentstiansferrredto: GFe—ater Lawrence Sanitary Vistrid
Date:
Inspector-
gallons
Yes q-,/
IZ
TON" OF
SYSTEM P
DATE: ilvd
SYSTEM OWNER & ADDRESS
G RECO
YSTEM LOCATION
(example: left front of house)
RECEIVED
SEP - 3 2004
ki— bc�c Lou S-(-,
-.%'jFR
N .f
I
DATEOFPUMPING: S-;�VQJ_ QUANTITYPUMPED: ooD GALLONS
CESSPOOL: NO 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
LEACHFTELD RUNBACK
FLOODED
OTIFIER (EXPLAUS)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
coNTENTs TRANsFERRED To: G.L.S.1) V Lowell Waste