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HomeMy WebLinkAboutMiscellaneous - 30 VEST WAY 4/30/2018 (2)I L --j ;•�, inti �� � ,. _ —ar ALILFA F1 - 9 p ;;. n� eco'` Foin .,4Xy Cd "OCT - 5KA yxt ►Ir i✓ tV n \ti r •4�3 ' a�4 1i � t : a3 1N ri.•r , r.; �!. � i tt rpdt+ a• ., '' _ .P.has provided thtsform for use by local Boards of Health. Tfa�' ia�Rgj-jn puRecord must be submitted to the.local Boardof Health or other approving a `1r' - a: •' A. Faclllty Infgrd�tVon yvrier,' filling out 1 System Location o puoter,�use `. or4 the tab key Address to move your:; —7VIO • A .cursor • do pot �. '.: `use the Motu Clty/iown State Zip Code - ,Y key.System 0 : neP ti � �J '1 >, 1 , ° i , Jt _t t i , a i •7 i ,..,, , , i r:• Name t Address pf different from location).., , Ctty/Town StateZi Cod �'/ 9� - 47j5— Telephone Number ,° Pu►nping Rekord: r ��'�� 1-a;��3tta1.5'r•.1°a;ui 1'{,1i.1•t''�tl J.t r.� • 1.:! Datwof Pum In , /sem p 9 Date 2. Quantity Pumped: f Gallons 3; .1'yp9 pf,systam, ; ❑- Cesspool(s) 0-16eptic Tank Other (describe),. 14Effluent Tea Filter present? . ❑ Yes• lo' If yes, was It cleaned? El Yes ❑ No ,,Co�d�tlon,ofSysf Ir:Mq tt•I'�• r,•r ::I r°1 ��'.i11 i'. r ( .�'fJTO /���� �`T� . ❑ Tight Tank ..•.-..�.;'•;' . :1•^�;�;/r••i •� 4��/: i4'1�"i, ��'. t}1. Nat�3�•� .�si%".'�%:.a �`� 'j,' •' .tib. ���. , Y`4 11 rF.: ••�,N; r:',:. 'U) t{y. t�.. �� Iv. al, l...'p:.Yiili'•.,.... �.;'•�,;;,'; ;:.:;;Tr: ;. U: mb'on'. bre. oontents yvere'.divosed; ,4 �.` �';, �°� �'•'>HS :.S nature Hauler .r http://www.mas`s.gov/dej Jwafer/approvals/t5forms,htm#Inspect WonrAdoo�0&93 ide Ucenee Number 9//0 Date System Pumping Record • Page 1 of i 1 �LN Commonwealth of Massachusetts RECEIVE® W City/Town of /V0. it CJ()V<r MAY 11 2015 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. IQ r� 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. A. Facility Information 1. System Location: Add ss 1 4 _a C1 v/Town State 2. Syste Name Address (if different from location) City/Town State Telephone Number B. Pumping Record 1. Date of Pumping � Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) ptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: Zip Code Zip Code A,�za Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No � j v 6. Syst P ped By: Name Vehicle License Number S s is Service Comp 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Signature of Receiving Facility Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 RECEIVED Commonwealth of Massachusetts L City/Town of No Andover JUN 10 7013 System Pumping Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 7` 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. 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 Important: When filling out forms 1 on the computer, use only the tab System Location: key to move your Address cursor - do not No andover Ma use the return City/rown State Zip Code key. 2. System Owner: Name {` I ILEI Address (if different from location) City/Town State Zip Code Telephone- Number - B. Pumping Record - 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Y7/11 No 5. Condition of System: 6. System Pumped By: Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No Name Vehicle License Number Stewart's Septic Service Company 7. Location"Where colent nts were disposed: teiart's Pre -treat Plant, 20 So. Mill Bradford, Ma 01835 Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 Date.? el RYPI TOWN OF No TH ANDOVER 0 P PERMIT FO PL GING This certifies that ...................... has permission to perform .... A.,r. .14- ...................... plumbing in the buildings of 4 jP! 7 . . . . . . . . . . . . . . . . . . . at ... —z . .......... North Andover, Mass. .... Lic. No. .l.. ........ P IVIBING INSPECTOR Check ff 7036 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location J 0Owners Name Type of Occupancy New Renovation Replacement Date 7 6� Permit # 6 �� Amount Plans Submitted Yes ❑ No ❑ (Print or type) Installing Company Name Check one: Certificate orp. Addr Partner. usrness a ep one Firm/Co. Name of Licensed Plumber: % d &-I Insurance Coverage: Indicate the tv of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ® Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued Cor this application will be in compliance with all pertinent provisions of the .Massachusetts u b e and ter 142 o ws. By:Sign, o icense um er y of Plumbing License Title City/Town tcense um er MasterJourneyman APPROVED (OFFICF, USE ONLY 13 1' ►I lomm MM MM����� ' MMM -----------------�---- MM MM mmmmmmm M MMM MMM (Print or type) Installing Company Name Check one: Certificate orp. Addr Partner. usrness a ep one Firm/Co. Name of Licensed Plumber: % d &-I Insurance Coverage: Indicate the tv of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ® Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued Cor this application will be in compliance with all pertinent provisions of the .Massachusetts u b e and ter 142 o ws. By:Sign, o icense um er y of Plumbing License Title City/Town tcense um er MasterJourneyman APPROVED (OFFICF, USE ONLY 13 Date ...'7 . . .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. has permission to perform.. ..................................... wiring in the building of ........ ............................................ at ............ ........ . North Andover, Mass. % .Fee ..................... . ..... ELECTRICAL PErcm Check # _2 6828 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. s P Occupancy and Fee Checked �s BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPF yALL INFORMATION) Date: City or Town of: //, ����d I/�,Q To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3 D 4,�S �j- ST Owner or Tenant /'cre ya Telephone No. Owner's Address 5, Is this permit in conjunction with a building permit? Yes ,� No ❑ (Check Appropriate Box) Purpose of Building .I G/ 4. , /1, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity 100� If/2 4z o Irl Location and Nature of Proposed Electrical Work: i Comvletion of the followinP table may he waived by the tncnortnr nfWiroc No. of Recessed Luminaires 6— No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency ig mg Batter Units No. of Receptacle Outlets /f No. of Oil Burners- FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Mun'c'pal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 32o a ' (When required by municipal policy.) Work to Start: 7-a 7- 0 6 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 01.4. ' 0�- uVk r A,`n 1 certify, under the pains and penalties of perjury, that the informati n on this application is true and complete. FIRM NAM A✓,,e o A, j_ IC. NO.: -6'3-02,V-,5- Licensee: ill0 k-,rl e si A,) pdi, Signature IC. NO.: 6' Z� (If applicable, enter-"exenypt11 in t1l i ens tuber line.) �s. TeL No.:loe 3 Address: -o t ode i Alt. TeL No.:loo 3 d 9f 3v,r *Security System Contractor License required f6r this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No.PERMIT FEE. $ �., e `-� � %� -fid-.e �,� 4. ,� L' 1TI�i't,. :v".�'lY.ii:d.l. \.e� ,,`k1�7w� • �r 7 hYi;:r:•�s , , t•. ' .C�Ee�V�;T¢��i �y.'�,r�r�.���y.r• v:f oa; � REVE' 'wrr�v i DEC 0 6 2005 OWN ()} (�Ux i'1i ,'.k,,(%W�IOFNORTHANDOVER ua i'a - SYSTTt,'I PUMPINu ACTH DEPARTMENT ADDREsS C30 7T, IF 71TY C01FQOL; NQ '"' Yvpuc I'cne n,• Nn rvxu c)Y J�RY1C8' rVU. iV lY7�r}c AYY Oss _ ��'P1.85 IN PLA, i,, . g�iC�S$iY�.�Ot,l®� .,..., Z�'�N1.t7 �uNlin�.•►, . ON BR EXPLAIN 6•r d vtr I'I;n}'� tii�irlyt�X U. 4 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 10/27/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X ) by Peter Breen at 30 Vest Way has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # dated — D -Boz Only. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. . " a ."'� � Board of Health Inspector TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 10/27/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X ) by Peter Breen at 30 Vest Way has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # dated — D -Boz Only. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector M O Z E `o LL w •** OJgR CL) a a C b4 � i �• ,.I gtr° 2 Q! o U MO1 *yrt w Q Z Q N c CL) a a C b4 O Q! o U c Q •O pt, = LA N ro E N a� tAtA J w N L" b a LL o Z c E L ro v o Z 0 Z Q N N L CL) a o C b4 U L Q! o U c o c c ro LA N ro E o`o a� tAtA L N L" a o p E L ro � N a � h � t-4 L a J U9 2 N-� TOP FOUNDATION HOUSE OUTLET SEP= TANK INLET SEP71C TANK OUTLET D -BOX INLET D -BOX OUTLET END OF F ELD EXISTING 145.19 142.99 142.46 142.24 142.11 142.01 141.08 ASRUILT 145.19 14299 14232 142.22 14211 14201 141.08 SCALE: 1"= 50, I CERTIFY THAT THE AND SNOT URE SHOWN ABOVE LIES ENTIRELY WITHIN THE LOT LOCATED OF MqLINES AS SHOWN WITHIN A FLOOD HAZARD AREA AS. SHOWN s ��. Sic ON FLOOD HA ASURANCE RATE MAPS OF THE FEDERAL EMERGENCY 'sem MANAGEMENT GENCY. ED CARD N� COMMUNITY PANEL N0. 250098, DATED JUNE 2, 1993• 18 1��3 HELMES, R. 1 No. 37733 F �orF�s9 1 t�S�VJ�� f /4�2 PROFESSIONAL LAND SURVEYORDAIS 'EREDICES PLOT PLAN 30 VEST WA Y N. ANDOVER, MASSACHUSETTS PREPARED FOR KAL-RICH CONSTRUCTION EDWARD C. HELMES, JR., P.L.S. 4 LANCASTER AVENUE CHELMSFORD, MA 01824 27, 1999 1 DWG. NO. 992721 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 0 �� CURRENT INSTALLER'S LICENSE# - LOCATION: �0 LICENSED INSTALLER:(-- SIGNATURE:TELEPHONE# CHECK ONE: OW q REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 575.00 Fee Attached? Foundation As -Built? Administrative Use Only Yes No Yes No Floor Plans? Yes - No Approval Date: �1 sa / D/ZZ/q.7 - SCALE: -=1" 50' ' O EDWARD C: 14El.Mo 9,ik ` LOT 42 47,156* SO FT. qY EXISTING PROPOSED TOP FOLMARON 14519 14119 HOUSE OUTLET 14299 14299 SIVIX TANK INLET 142.46 142.46 SEPTIC TAN( (XJ ET 1424 142.24 14?.1t 14211 D -Box louur D-wz OXET 142.11 14111 EIo OF FIELD 141.09 141.00 I CERTIFY THAT THE STRUCTURE SHOWN ABOVE LIES ENTIRELY WiNiN THE LOT LINES AS SHOWN AND 15 NOT LOCATED WITHIN A FLOOD HAZARD AREA AS SHOWN. ON FLOOD HAZARD INSURANCE RATE MAPS OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY. COMMUNITY PANEL NO. 250098, DATED JUNE 2. 1993. ltlaw, f i• ���rsd � /'1AC��I � OG7aQ/IF.1f b I!� O , it PROFESSIONAL LAND SURVEYOR DAT[ PLOT PLAN - 30 NEST WA Y Al A ArnnVVP llld_� SQ �fTUSETTS tsa v PR/O�/POJ/S���f��O i 1500 w- J r RoPOS SEPTIC TANK ADDINX r 05 ss• 51 OFFSET PROPOSED lir z 1/2 STORY ' 3s' 6 O O n LOT 42 47,156* SO FT. qY EXISTING PROPOSED TOP FOLMARON 14519 14119 HOUSE OUTLET 14299 14299 SIVIX TANK INLET 142.46 142.46 SEPTIC TAN( (XJ ET 1424 142.24 14?.1t 14211 D -Box louur D-wz OXET 142.11 14111 EIo OF FIELD 141.09 141.00 I CERTIFY THAT THE STRUCTURE SHOWN ABOVE LIES ENTIRELY WiNiN THE LOT LINES AS SHOWN AND 15 NOT LOCATED WITHIN A FLOOD HAZARD AREA AS SHOWN. ON FLOOD HAZARD INSURANCE RATE MAPS OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY. COMMUNITY PANEL NO. 250098, DATED JUNE 2. 1993. ltlaw, f i• ���rsd � /'1AC��I � OG7aQ/IF.1f b I!� O , it PROFESSIONAL LAND SURVEYOR DAT[ PLOT PLAN - 30 NEST WA Y Al A ArnnVVP llld_� SQ �fTUSETTS tsa Oct 13 99 01:45p 10/13/1999 11,30 9782441299 Nick Kalergis 978-589-5163 p.2 EN C 1-LMES JR PLS PAGE 81 SCALE: 1"= EDWAi1D C. HELMES, JR. No. 97793 EXISTING PROPOSED TOP FOUMA17ON 14119 14119 HOUSE OU}i£T 14299 }4199 SEPAC TANK fwrt 14246 142.46 smw tAlw( OuArr 1s22f i421t 42-24 O-s01r our 942.19 142.0} EMDD-sOF IElO FaD T<}.OB 141.00 EIS O 1 CERTIFY THAT THE STRUCTURE SHOWN ABOVE UFS ENTIRELY WITH" THE LOT LINES AS SHOWN AND IS NOT LOCATED WITHIN A FLOOD HAZARD AREA AS SHOWN ON FLOOD HAZARD INSURANCE RATE MAPS OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY. COMMUNITY PANEL NO. 250098, DATED JUNE 2, 1993. a- /�� aworreaewu u PLOT PLAN 30 VEST WA Y N. ANDOVER, MASSACHUSETTS PREPARED FOR TIAL -RICH CONSTRUCTION o pow" 'w, 07-V EDWARD C. HELMES, JR., P.L.S. 4 LANCASTER AVENUE CHELMSFORD, MA 01024 1899 DWG. N0. 99272 )inJ ©-FI OF4i;FA-- . 3 1999 D i�_ ->� �, ,, �� _ is �� �`"-� � S✓S Oct 13 99 01:44p Nick Kalergis Karl Rich Fax Note I! fff 2 Lawson Road Westford, MA 01886 Phone: 978-692-0256 Fax- 978-589-5163 To: Susan Ford Fax.- 978-688-9542 978-589-5163 p.1 Number of pages sent including cover: Date: October 13, 1999 Susan M Dwj tF EEcr e 3 Here is the certified print of the proposed tank relocation to be performed by Peter Breen. If you have any questions please page me at 978-488-8954. TAwk You Nick Kalergis Kal Rich Construction I q I ti LOT 42 47, 156 � ING cv FND., 1-245 iu 34 53 kit f 144o KOTE:I CERTIFY THAT THE SEPTIC SYSTEM 1I A9 I NsTALLED AS SHOVIN-THI S PLAN IS NOT WENDED AS A WARRANTY OF THE SYSTEM. 4 - 0 TOP FOUNDATION HOUSE OUtLET SEPTIC TANWINLET SEPTIC TAf4- LET OUTLET D -BOX INLET 'o -Box OUTLET -fNO OF FIEW v ELEVATION 14SA9 142-99 142A6 14224 14.2-11 142oOl 141.8:1 LOT LOCATION PI ARTY LINES AND DESIGN OATA FROM FC.GEL4 NAS AND ASSOCDATED 3-17-8t REM -27-81 PLAN SHOWING SUBSURFACE SEoERAGE DSPOSt-\.LSYSTEM ASBALT LOCAMN.-LOT 42 VES"ll" WAY OWNER" J.J.AND E. REALTY TRUST' SCAB, -,E l-' 3 DAI E I t 't., -S(- c FUNN jO 9 s 9 DtBOX INLET 1426 I 11YBOX OUTLET 14101 c.; O'oF FIE D.. (41.8f t LDT LOCAL oto PROPEfZTY .U?I,ES AND DESIGN DATA FROM F.C.GQ. NAS AND ASSOCIATED t 17-8f R€VD7-27-$1 i •. i^"+'srw_''....�i'A.+..aN++,rw^-""!"---«.niw.r�c....a.�»'.++„�...,,,,..�w, } 1 I 1 l NOT EV cER-My THAT THE SEPTIC SY'S` tM WAs � SEWERAGE DISPOSE%L- 8 1�:;.7 � y INSTALLED SHQWN.j 115 PLAN IS N(3� " _ e 4 EST -WAY -INTI IAs,A WARRANTY of THE sire.. L� �No �..C�3' 11 QNER J�,.AND REA.TY TRUSS SCAIE i='` -t 1-1=8 i ,POEFAREO'8Y----ssoc C FLY) i t 'o, po 'o �A P C��8ov 9 " t i S ` , t LOT 42'. } 4 ' L LL �!T f'hTION s TCP. FQt1N13O©N 148.19 - , 'HOUSE UItET 142x9 -SEPT-1CTW} INLET 1446 SEPTIC TANK OUTLET 14 2, 412 4' DWX INLE- 142011 .0 -BOX OUTLET 142at31 END OF FIZIM .141.81 \� EXISTING - F'ND? y s ' - .. ,...11..14. , � - ' • ,�'r � ' i LDT'L,OCATION PRI ?E ?Y LINES APD i ATA •FIS- KCeG il?WiAkoA$S T1=D . `17-8t` i - Y _ t , 1 REV.7 Fl�ii,ti}fl J 4 _ s .wJt \i f Ida• m.0tE.I*CER7n t-iAT �'1-11r EEC 5Y5TE`M,VVAS a�r D1 i 1N5`tAj„!_.1~[ AS t✓.►!, 7a NQ -- y n~ i' , y} - t T1 �s.n'rgt►N�rY o T sYn. _offlON:` `l' } '�r SAE I`H� - ANW-, SSOC yr F y'O69'. �F � PL ISTOW N 03865 T0: NORTH ANDOVER, MASS. _ Dec_. 3,_ 1982 BOARD OF HEALTH FROM•• Alfred A. Shaboo, P.E. DESIGN ENGINEER Re: Soil Absorption Flynn'Assoc. P.C. Sewage Disposal System This is to certify that 1 have inspected the construction materials of sdid i s p o s a l system a t ---Lot-442 V est_ W ae__ Site location North Andover, mass. t The grades and construction materials are as specified in`x plans and specifications dated Ju1y_2719_81 and As -Built Nov_6 1982 Reg. Prof. Eng' eer7� n UFNI, T cr.'FiX IffvT M WATE DISC 1'1'?R�U*VED DATE_ c) ted: 'title as Reg 2.5 The subrdtted plan riraht sow as a rte, xJ=.,m: the lot to be served -arm., dimcT,,q, one lot #,,ahuttars location and log deep observation boles -distance to ties location and results percolation tests -distance to tics design calculations & calculations showing required leaching area "71 Q' location and dimensions of system -including reserve area I) existing and proposed contours g) location any vat areas vithin 1001 of sewage disposal system or disclaimer -check wetlands mapping face and subsurface drains within 1001 of sewage dish osal system or disclaimer - lot altdoan arq &.5?!v'4age esteztznts vItIO-n 1001 of se%Age clixpc-sal systm or discl.nw,-Plxaaring Board files 1mown sources: of star s`ipply wits-: m 2001 of n6-,:a-ge disponal &7ptw or disclaimer Location of any proposed vell to serve lot -1001 from leaching facility (1) location of water lines on property -101 from loai:��Ing facility (in) location of benchmark (fi) driveways 7 o} garbage disposals (P) no PVC to be used in construction I(q) profile of system -elevations of basement., p'L=h, Pipe, Septic tame, distribution box inlets and outlets., distributiewn ilteld piping and Otter elevations r) maximum ground iater ele-7ation in arm sewage c"Irt, systAm 1XII (s) plan nPast be prepared by a Professicnal Eagin&er or oC,',.er professiorml authorized by law to prepare swh plans Reg 6 Septic Tanks (a) lie=s- 50% of flow, imter table, tees.9 depth of ceesj access., ping N cleanout C) 101 from cellar wall or inground svi=ming pool J(d) 251 from subsurface drains Reg 10.2I Distribution Boxes 'A/dslope greater than 0.08 I. -g 10.4 sump War TRUE. `VITW 12'S7%oPF_ U(uOS(Z P(PE -rH%S N"EtOS(OfJ swow.b ism IL 4." :STAiAp 4-Sld �J GAi 1Gv Iww..war�..—.w—.,..ws..'.w Reg 11..2 li.4 y11.10 11.11 Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 1t•4 1.11.6 2-4.7 14..10 Reg 9.1 9.6 .ti [: Jhmk, a.•.aww+...+,.+m. M,�•�l mr+..w...iwv.. .-vwwa...+a+r � .w...a.....-.xs..v.narrsww. ...4r.•us a.iL•..wa...,....,.a........+—.�,t-..x..w....�r:x+w....w,v.+r++fir.-..es.+.r�ra.+^rw...n�... M-.+...............ar....e f.eucIji ng pits are preferred i*cere the installation is possible a) calati.l-ations of leaching area-rdaim-A 5D0 eq ft b) spacing c • surface drainage 2% d� cover material e) 21%2'"A" splash pad f) teefat elbciw no ends in pipe from a -box to pipe L Fching 'fields Eo greater t 20 minutes/inch � a area -mini=m 900 aq ft c construction of field d) surface drainage 2 % e) 201 from cellar Nall. or inground s�4mdng pool Leaching, encases -- a) cal a a o eaching area-mfn 500 sq ft b) spacing s ft min 6 ft with reserve betvaen c) den ons d) cons ction c) etch f) sur ace drainage 2% - Downhill Slope a) ss'-ope y%x = �to be shown) b) y/x a 150 (to be shown) a) 'ap val. b) stand-by power FPTL PK � Pit Number SOIL PROFILE & PERCOLATION TEST DATA.. 3 4 S Start Saturation North Andoverl5ss. No.&Street Lot No. Loc./Subdiv. Plan Owner Invest5_gator ( ( Observer Start - Test -Time =_-_=. ___- SOIL PROFILES --DATE -777 -- 1. Elev. 2' Elev. 3. Elev. 74'Elev. Drop of 6" -Time 1 1 1 1 Percolation Rate Ties to Test Pits 2 2 2 2 3 3 3 . .3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7 8 8 _ 8 8 . 4 9 - . .9 _ 9 LO 10 10 - 10 Benchmark Location Elevation Datum Percolation Tests -Date Pit Number 1 2 3 4 S Start Saturation _ ._ ...._ Start - Test -Time =_-_=. ___- -777 -- Droo Drop of 3" -Time - Drop of 6" -Time Mins_ 1st. 3"Dro Mins_2nd 3"Dro - Percolation Rate Notes & Sketches on Back 3oard of 'Health 3orth Ank-2 sz". A.4 t2090 W SEPTIC SYSTEM INSTALLATICK CHECK LIST SAPFttCIVIDDATE LOT e 1. Distance TO: a. Wetlands: b. Drains ` c. Well 2, Water Line Location 3. No PVC Pipe 4. Septic Tank - a. Tees -_Length & To Clean Out Covers b. Cement Pipe to Tank - On Both Sides of Tank 5• Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Inds d. Clean Double Washed Stone 7. Leach Pits a; Raads s b. S e Dth c. lash d Tees Ceaa®nt Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System e. Location with Regard -to Pere Test d. Elevations e: Water Table 1/117lfi , t Commonweafth of Massachusetts Executive Office of Environmental Affairs Department of Environment®1 Protection WIIllam F. Weld Governor Trudy Coxe Secretary, EOEA David B. Struhs Commissioner ION. , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ev Property Address: 4 Address of Owner: Date of Inspection:' "{ (If different) Name of Inspector: l'bf G�Si Company Name, Address and Telephone Number: 41-7 CERTIFICATION STATEMENT 0 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: C ') 2-- 1� 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 s 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. .f The original should be sent !c, tho system owner and copies sent to the buyer, if applicable and the approving, authowi _ INSPECTION SUMMARY: Check A, B, C, or D A],SYSTEM PASSES: I1 � I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. ,,rAny failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: t `�l One or more system 'components in d' 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) 1 8 One Winter Street • Boston, Massachusetts 02108 • FAX (617) S56-1049 • Telephone (617) 292-5500 { A . +i1 Printed on Recycled Paper .+t?k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property. Address: Owner: C^ Date of Inspection:*'"" x1 B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or hih 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 thad�four times a year due- to: or obstructed pipe(s)s.The system -will -pass inspection if (with approval of the Board'of Health):' t broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 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 ,vctem nas a septic tank and soli absorption system and is williiit 100 feet surfa-_e 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. r _ R 'The system I- aseptic tank and soil ibsoiption system a'n8 is' less than 1'00 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: v determined that the s stem violates one or more of the following failure criteria as defined in 310 CMR 15.30 I have de e y g 3. 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 clogged 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) 2 Yh{.nr 1:- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ''PART A CERTIFICATION (continued) Property Address:. Owner. Date of Inspection: D) SYSTEM FAILS'(continued): 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 day flow.. Required pumping more than 4 times in the.last year NOT due to clogged or obstructed pipe(s). Number of times pumped 41 _ Any portion of the oil Absorptiori Sysiem, 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 iswithin a Zone 1 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: %,�' The following criteria' apply'to large.systems in addition to the criteria above: The design flo\ti, 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 K the. system �s located rn a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public�wafer°up'pl) we'Il'"..' �.:..'.".r••:.. ;f.:: The owner or operator of any such system shall .bring the system and facility into full compliance with the gro undwater 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 `41 � .. . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART E CHECKLIST ' Property Address: P G R! `� I7i 0 U V Owner: ! 1 Date of Inspection: Check if the �following have been, done: P roping inforrnation was requested, of the owner, occupant, and Board of Health k' _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow.rates unng that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As 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. The. system does not receive non sanitary or industrial waste flow fThe site was inspected for signs of breakout. .' All .system components, :excluding the Soil Absorption System, have been. located on the site. T,he septic tank manholes were uncovered, opened, and the interior of the septic tank, was inspected for condition of baffles or tees, material of construction, dimensions,, depth of: Iiquid, depth of sludge, depth of. scum. _ The size and .location of the Soil Absorption System on the site has been determined based on existinginformation or approximated by non -intrusive methods. _ The.facil I t) o,%; cr land occupants, .f differen! from owner) mvere provided with information .on .the proper maintenance of Sub - Surface Disposal System. - - r. —. M .'�'.,.�,.�. ,a�'P_*S. •w •.v s...r yp.r. ac,.� � ss;,.R.�..�- -4p++r-•4"..r+,ar"f .,w •.r _ �t �• w �" �+ �... �- _ s -y .. (revised 8/15/95)' 4. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G SYSTEM INFORMATION . Property Address %r?�j Z Owner: f Date of Inspection:, ,FLOW CONDITIONS,.' RESIDENTIAL Design flow: 60 o gall ns Number of bedrooms: Number of current residents: Garbage grinder (yes 'or no):° Laundry connected to system es or no):_?5 . Seasonal use (yes or no):ci Water meter readings; if available g Last date of occupancy. COMMERCIAUINDUSTRIAL• Type, of establishment: Design 'flow: Kallons/day Grease trap present:, (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non -sanitary waste discharged to the Title"5 system: (yes or no)_' Water meter readings,. if available: Last date of occupancy OTHER: (Describe), Last date of occupancy: '. GENERAL INFORMATION PUMPING, RECORDS and source of information: System pumped as part :of inspection: (yes or no)_Y-PJ elf yes volume pumped gallons i Reason for pumping, • s • . 1 �� � C'�c- y li.�«t t to .� _ . .� ; 1 x � �• �.; ,. '`...., .r;... �,.,'.: r met- ;a •ri' F Mt M- '�"" ir TYPE F SYSTEM Septic tank/d1stribution 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: i,. Sewage odors detected when arriving at the site: (yes or, no) (revised 8/15/95) 5 _. ,..... .._ .�. ,.. a.e..__..-�:, a. , .�,,... r „yt. p. .: _. •.. .,i •-. s ..�?.. .'.Y,—'•ry, :- Y,' y "ham , . _ .. .. . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM :IN.FORMATION (continued) Property. Address,:i S (% AY Owner: Date of Inspection: SEPTIC TANK: plan) (locate on site p ) Depth below grade:,,. Material of construction: _concrete metal _FRP other(explain) Dimensions: Q s q Sludge depth: a Cpl' „f # .ye, s Cw �s,F .4'•. =fit ' y,. s; Distance from top oftluflge to botto of outlet tee or baffle: Scum thickness: Distance from"top .of scum to top of outlet tee or baffle: t* Distance from bottom of scum to bottom of outlet tee or baffle: . 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:) 1-4 GREASE TRAP: ., (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP _other(explain) . Dimensions: Scum th cki ess. Distance from top of scum to, top of outlet tee or baffle Distance from hottom no sruM t" hnttnm:Ot outlet tee or battle Comments r. r ,(recommendation jor, pumping, co,ndit,o,n of inlet and outltet tees or b4ffles depth of liquid leve4in relationjo outlet invertstructural. r integr'ify, `evidence 'ot I`�ak�ei ;weir.., r e :. ( c;. a ...n.,. v .. ,; _-. ..,..... .... ..•_ _,, ;..-mow. ,. ....� `... _... ..., r e , _ .. ,e.Y: .y:: `,a vy,�7 ,.v � .. r .. _ ... as SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C t SYSTEM, INFORMATION :(continued) Property Address-.' Owner: 'Date of Inspection; TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade,: Material of. construction: _concrete metal _FRP —other(explain) Dimensions t A," Capaci y v gallons t ^ Design flow ( gallons/day Alarm leve.l:,.. Comments: (condition of. inlet tee., condition of alarm and float switches, etc.) DISTRIBUTION BOX:f (locate on site plan) Depth of liquid level above outlet:'invert:�1 U eke Comments: (note if le,,'c! and d;str� : t e �, e•id^nce of cn!i(jt' ca n nvPr evidence of leakage into or .out of box, etc.) f 6 L�aDd h r'GMp�?/c L/ //L(r llli7/ FPUMP CHAM$ER , , , c t 3 +s � � t.e t 'f ¢ :+ �t :t (locale on 'site' 'lan) 4 � Pumps in working order.(yes or no) .f ,x Comments:. •(note condition of pump chamber, condition 'of pumps and appurtenances, etc:) (revised 8/15/95) 7 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION (continued) Property Address: Owner: tZ.*, Date of,inspection: SOIL ABSORPTION - SYSTEM (SAS): V-0 P,r_17 (locate on site an, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type: leachir V pits, number: leaching chamIjers,. numbe leaching galley es, number:— leaching trenches, numberjength: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition, of vegetation,etc.) '6 A(V /?`/U J a / 41 eY6 9 P4 19 -lu 1-14 42 z V e., CESSPOOLS: (locate cate 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 ,(signq.,of.hydrablic failu(p, level of pondirig, condition ibf vegetatioln, etc.)Y j, PRIVY: (1,6cate 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) 8 S,, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (/ 8`� W �9 y � Owner: Date of Inspectiony SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two.permanent references landmarks or benchmarks locate all wells within 100' i 57R r cr DEPTH JO GROUNDWATER Depth''togroundwater feet Q method of:determination or approximation: 17� 1% /� ' (revised 8/15/95) 9 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD I).ATE: C 1 -j1 "! v YV IN R & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: � ��QU`ANTI`TYPU�MPE`DJ6�GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE —1z ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: = O:'vIMENTS: O \'TENTS TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE -- LEACHFIELD RUNBACK FLOODED ---- OTHER (EXPLAIN) OR OF OF TOWN OF NORTH ANDOVER SYSTEM PULPING RECORD a ®ATE SYSTEM OWNER & ADDRESS ✓' 1 e1217 ✓ SYSTELOCATION DATE OF PUMPING I b QUANTITY PUMPED CESSPOOL NO-,-" YES SEPTIC TANK NO YES NATURE OF SERVICE: ROUTINE � EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPER BY S COMMENTS: CONTENTS TRANSFERRED TO ProYldrd 0� IVb/nl119d 10 1Y11 hii folm 1?, I BCrrC C'1 nOJ In A, F a c I I 1—ry- —1 n—frl � ­­lj o. n L VV HI ?04 m H�US E T7 wmPiu,o,. y. Oslo Pf Pvm91Aq'.;-. L7 COMM() z3opoc Too, .......... . ' (describe fm; fn; f* Fill!( lvo .............. .. ... .. ........ .. .. ........ Y Will f it 0 .. 11YI, I 91h m 6 p� 'i (#'i/i 1�l A Commonwealth of Massachusetts RECEIVE® City/Town of NORTH ANDOVER MASSAC S . Sg Wo System Pumpin Record " r� Form 4 g LNN OF NORTH ANDOVERALTH DEPARTMENT 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 Important: When filling out 1 fors on the computer, use only the tab key to move your cursor - do not use the return key. 2. System Owner: Name Icy l n Address (if different from location) City/Town State Telephone Number Zip Code B. Pumping Record L 1. Date of Pumping Date 2. Quantity Pumped: Gals 3.. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank •f] Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By Fran % 32pi Ic Company 7. Location whep contents were disposed - SC) thII1 c = Signature of Hauler http:/Afvww.mass.gov/deptwater/approvals/t5forms.htm#inspect t5for4.docc 06/03 If yes;'ovas it cleaned? ❑ Yes ❑ No Vehicle License Number Date System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECOV0 Cityfrown of System Pumping Record '��11 Form 4 TOWN OF NORTH ANDOVER ig I 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information - en filling out ns on the router, use t the tab key none your ;or - do not the return System Address North Andover City/Town 2: System Owner pp Address (if different from location) City/Town ma 1 01886 State Zip Code State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: - Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Aystetp Pumped t M c - N �\ NAe— Vehicle License Number Stewart Septic Service Company 7. Qocationfrei re ntents were disposed: St wartstre tment Plant 20 So. Mill St Bradford Ma 01835 Signature of H ler Date Signature of Receiving Facility Date xm4.doa 03106 System Pumping Record • Page 1 of 1