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HomeMy WebLinkAboutMiscellaneous - 32 EQUESTRIAN DRIVE 4/30/2018 32 EQUESTRIAN DRIVE 2101105.D-0139-0000.0 v e I i I Commonwealth of Massachusetts City/Town of System Pumping- Record Form 4 b DEP has provided this form for us&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/Right front of hou" Ainha.Teft ig rear housLeft/right side of house, LeftRight side of building, Left/Right front of bu''ijj /Right-rear-6f.building, Under deck Address � •-\ ����j �. C�1,,� 4�, �'�-�C�'v"�R`� ���-'w`,,��'`S�� citylrown State Zip Code 2. System Owner. Name ` Address(if different from location) 1 cityrrown ' Stat Code Telephone Number s PIK B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Canons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yep If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition 6.- System Pumped By.- Neil y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location—where contents were disposed: 3. Lowell Waste Water Sig HauleV Dam t5fbrm4.doc•06103 System Pumping Record•Page 1 of 1 . 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. 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, a Righ r of ho , Left/right side of house, Left/ Right side of building, Left/Right front of buil Ing, Left/Right rear of building, Under deck Address Cityrrown V State Zip Code 2. System Owner. v\,,e_,C` Name Address('if different from location) City/Town Stat' Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Qu tity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No; 5. Condition of stem: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number ._ CoompnBateson Enterprises Inc DEC 09 ZU 13 7. Loca:L!.Snj, tcontents were disp osed: I TOWiq C.:.. = •.•., _ - LowellWaste Water Sig4je j9f Haule Date t5fomm4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF INV SYSTEM PUMPING RECORD RECEIVED DATE: DEC 0 2 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of hoose) -e� r'e��C)-F-' DATE OF PUMPING: �'`✓ r QUANTITY PUMPED : ` 5?GALLONS CESSPOOL: NO SEPTIC TANK: NO YES EMERGENCY NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: - 6-O SYSTEM OWNER &ADDRESS SYSTEM LOCATION UOcj ne c (example: left front of house) te, ;4f 16 r�-- �r 1-eg� 661ccy 0-�- �10'xsc- r(7 DATE OF PUMPING:]—(,o —0 I QUANTITY PUMPED ► 5al GALLONS CESSPOOL: NO J YESEP S TIC TANK: NO YES NATURE OF SERVICE: ROUTINE ZEMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: 7YSTl` . COMMENTS: 7- " 3 120 t CONTENTS TRANSFERRED TO: Add &- rIQ0 �, Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ filum• Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department TOWN OF SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION W� vi / (example:left front ofhouse) ^1�//� 01v' V AA— ug�Jv UT L DATE OF PUMPING: 1-1�3QUANTTry PUMPED : [/ '5, GALLONS CESSPOOL: NO L/ YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: cONTENTS TRANSFEMED TO: G.L.S.D `/Lowell Waste Lor 7 cc)L-/EsT W'j A?FU C*J I_ WY5C>Cr- l wA��� Sc�PPL7 Q TbWnl D WELL APo�CDD4TC SS �' - — StPTic 5'Y STF-M VESt6AJ �PP�{p\iEv 1�Ar�' APRzOVW6 Aurhoi?)Ty C8/1DI T Otis= r �l SQPPKp V�p D/�I E ��QSONS , prf c SYSTEM 1 j STA u..dTl OA1 C74V4T(o, J 1tiSPj�-GTrp,v 94rG ❑ P/JSS ❑ FAIL-, FwA� 11�5P�Tlon� APPROVED /STC r�-z��� ���r�v►N� �a�r+�o����y A�J�IT�D�AL I�SI�zi(ON5 �1%A►�Y) DtSAPPROvF,D DArC R£05o rvS•, FK)4L APPI�DVAL D,o��,. (blG-2q APP►�a��G �v iHo�'I ► � Commonwealth of Massachusetts "Ulk Massachusetts System humping Record System Owner System Location ill 0, 5 Dale of Pumping: � C' � Quaidity Pumped: l6��gallons Cesspool: No Yes LJ Septic Tank: No U Yes System Pumped by: 4redere t5fi.Aci rMed License# Contents transferrred to : Greater Lawrence Sanitary District Vate: _ Inspector: n Commonwealth of Massachusetts ;ED ED City/Town of � System Pumping Record DEC 1 1 2007 J�< Form 4 rOWIN OF NORTH ANDOVER HEALTH DEP R DEP has provided this form for use by local Boards of Health.Other fo , 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 Important: When filling out 1. Syst forms on the computer,use only the tab key Address to move your ,- cursor-do not use the return Citylrown State Tp Code key. 2 System Owner: Name Address(if different from location) Citylfown State(0(s ^ —��Z�_ g Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): �—, . 4. Effluent Tee Filter present? El Yes Into If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: n©VR,� �v 6. System Pumped �� Name VehiGe License Numb Company 7. Location re conte 'sposed: 17TIll Signatur ra I Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of W° System Pumping Record 010 Form 4 � 14 l DEP has provided this form for use by local Boards of Health. OthtMIMME e information must be substantially the same as that provided here. k 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 oca ' : Left front of house, right front of house, left side of house, right side of house Le rear of ho e ' t rear of house, left side of building, right rear of building, under deck. Cityrrown V State Zip Code 2. System Owner: r p Name Address(if different from location) City/Town Stat ( _(pnCode Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Loca here contents were disposed: .L.S. ell Wa to Nter Signatur4 of HaAler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record �M yv v Form 4 JAN - 4 2012 DEP has provided this form for use by local Boards of Health. Other fo N A Ee information must be substantially the same as that provided here. Befo e us 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 hous , e Rigrear of , Left/right side of house, Left/ Right side of building, Left/Right front of bul ing, Left/ ight rear of building, Under deck Address Q V\ ^1 ( 0 u Citylrown V State Zip Code 2. System Owner: "r Name Address(if different from location) City/rown Stat ip Code Telephone Number B. Pumping Record S-- 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. 4Signitufe here contents were disposed: Lowell Waste Water I a —r Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED .° System Pumping Record 30 NU Form 4 JU �y TOWN 07 NG1.7,-i ANDOVER DEP has provided this form for use by local Boards of Health. I -Wy4' , 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/Right front of house, eft` ight ear of ho , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner. A 1 4 - v\ Name Address(if different from location) City/Town Stat ip Code -fib Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition o;System: ry v 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: .L S. Lowell Waste Water (a SignAtufe cf Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1