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HomeMy WebLinkAboutMiscellaneous - 324 BRADFORD STREET 4/30/2018 (2) 324 BRADFORD STREET et J' 210/061.0-0019-0000.0 i Y RECI"VED Commonwealth of Massachusetts Ftp 0 5 2013 City/Town of North Andover TOWN OF NORTH ANDOVER m System Pumping Record HEALTH DEPARTMENT a Form 4 M 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. System Location: 1 on the computer, use only the tab key to move your Address cursor-do not North Andover Ma 01845 use the return City/Town State Zip Code key. 2. System Owner: j4o n m n U"\ yI��I Name reran Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1 1. Date of Pumping /d//V u 2. Quantity Pumped:ed:Date Gallons 3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): / 4. Effluent Tee Filter present? ❑ Yes C�No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: V© - 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: tewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signatur auler Date yl S' of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 I Commonwealth of Massachusetts R °CEIVE� W City/Town of No.Andover System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT 1M S'•y`e 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 1. System Location- forms on the computer,use only the tab key Address to move your cursor-do not No.Andover Ma 01886 use the return City/Town State Zip Code key. 2. System Owner: kAa�n c� Q-X� L) Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping a-�� 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No I 5. Condition of Syste VC.I 6. s em Pump Q me Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: �15/tewaoPre-trqatrneLit Plant, 207S0. Mill Bradford, Ma 01835 LSig re o aule Date / Signature of Receiving Facility Date ! t5form4.doc•03/06 System Pumping Record•Page 1 of 1 I I L s � 1 ! rS r�{/,r_Wr,T`^�� �s ��'i irvv4 irc ��rii.$'"`' i !��'i r,•Irr t .l ___,.___.__ .._. i �.� t;,4�4( M314� ;!+i �dl /. r7+711j ,•r,�ry , z .l/JL r t r t , ,r r u 0•F NO RT .r SYSTEM PUM;PrG .CO i o 42003 UWN�-R .& 'ADDRESS SYSTC kM_LOC ,T1'0 . mar1Q Ich rro nA of hour) Cckd Ck �t v � ! �iii ti S ��'�"���,•a•v-t:� 6•�. ' i .,.. � (/ • U ) I C OF PUMP►NC,' � ��` QUANTITY f'UMPD / C t. �:�•�I'UUL;'.'No' -YES SEPTIC TANK; NO YES -TUKE OF.SERYICE, ROUTINE.. EMERCEN'CY ��is>rriyATIONS; b,UUD CVN.UI.I:ION ' h'UI;L:TU CUYGIt hli'A',Y-;Y C,�tk'ASC' .l3a FLL IN I'I,ACI RU:O.TS L.EACHFICI,D IZUNl3AC'K.,, T ' XCESSIYE S0L1DS FLOODED'. 'l SOLID, CARR:Y�O.YER :p HER.. � Xf'IA.IN ;�! '':!'''�r�/��'�l��st��,_t�•Jl1�R ti4�X�r��tr� r'4tr 1���{' y4 � ��+ 1'. 1;/ r4 J ,�.� � CM PUMrc By, r' I , '1 ��u.�-i�IrNTsr • 1r 1 u I S 7 IZANsrc� 13L� v. J 0 i TOWN OF NORTH ANDOVER i SYSTEM PUMPING RECORD ' DATE: 11 12 c-) /C/,v SYSTEM OWNER & ADDRESS SYSTEM LOCATION d (example: left front of house) 1"z2' - -Z� DATE OF PUMPING: �� � QUANTITY PUMPED GALLONS CESSPOOL: NO ,/ 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: COMMENTS: r i . r CONTENTS TRANSFERRED TO: Address ST Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date.of Refer to other Purpose of Docurnent/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — ConIservation Commission — Building Department North Andover Board of Health Andover Septic 120 Main St. 47 Railroad St. North Andover Ma.01845 Bradford Ma. 01835 Haul Lic. #151-OOH December 2000 Install Llc. # 128-0 Date Name &Address Gallons Comments 12/1/2000 Murphy - 16 Crossbow Lane 1500 12/2/2000 Manzi -.72 Foster St 1000 - 12/4/2000 Grifin - 240 Candlestick Rd 1500 12/5/2000 Mcilvien - 57 So .Cross Rd 1500 Flooded 12/6/2000 Small - 440 Fosrer St 1000 12/6/2000 Orlando - 274 Foster St 1000 12/7/2000 Weger - 29 Barco lane 1000 12/8/2000 Walton - 161 Bridges Lane 1500 12/11/2000 Coflan - 73 Christian Way 1500 12/12/2000 Orlando - 7 Laconia Cir 1000 12/12/2000 Fitzgerald - Sharpner Pond Rd 1500 12/18/2000 Mangano - 324 Bradford St 1500 12/19/2000 Galea -= 1589 Salem St 1000 12/19/2000 Johnson - 91 Boston St 1000 12/22/2000 Senton - 1620 Turnpike St 1250 Flooded FAN - ,� VVil 5iL ANUANDOVER PAGE 02 lva(-6 YqN1)6ver 12.6. 4. )gyp .Al4rn .Sf 4 'S S�'IICC TAWA/a 0-1SFRV0-1hA ndQvRs- tRMD "d l Lir- t 5l -L� 1� BRADFORD, IA 01835 'nr4n ll L4 978-372.7471 MMU OFMWN u 1` oac llj,5(- Ih 4n DATE ATCR__- 3 Li Ic�� 7-21 -93 Town-iof North Andover Board of Health Atten : Bob Leyland re: Septic System Dear Sir; Regards your letter of 7/93 concerning the required pumping of septic systems in District 1 , you will find enclosed a copy of a, bill from BATESON ENTERPRISES Inc. and my cashed check #1192 showing that our septic-tank has been pumped on 5-12-93 . I trust this will fall within your ruling for having met the necessary time frame. Please mark your records accordingly. Cordially, Domenic J. Mangano 324 Bradford St. No.Andover, Ma. , 01845 i I HORTIy 4 Ot.„1O BOARD OF HEALTH o � t • , 120 MAIN STREET TEL. 682-6483 SACH UsNORTH ANDOVER, MASS. 01845 Ext. 32 Dear Lake Cochichewick Watershed Resident, In order , to protect , the water supply . in North Andover from improperly functioning septic systems, at a meeting on June 24, 1993, the North Andover Board. of Health voted - to adopt a ur P ; in the Watershed. Septic Systemuutpiny Rcg::lat�:;': �s.- published June 16, 1993 edition of the North Andover Citizen. This regulation requires all homeowners in the Watershed District to regularly pump their septic tanks according to a mandated schedule. Homeowners in your district, i.e. District 1, who are.- currently using a septic system are required to pump their septic tanks and report this pumping by September 30, 1993 . If you have pumped your septic tank within six months of this publication, you are requested to submit proof of the pumping and are not required to pump again for three years. Septic system pumpers who are licensed' to . haul sewage within North Andover will be furnished with "Septic System Servicing Reports” which must be completed and signed by both pumper and homeowner and returned to the Board of Health at Town Hall prior to the deadline prescribed for your Watershed District. .There are penalties for both pumpers and homeowners who fail to comply with this regulation. Those interested may obtain copies of this new Septic System Pumping Regulation from the Health Office at Town Hall. Thank You, North Andover Board of Health Dr. Francis P. MacMillan, Chairman Gayton Osgood, Clerk Dr. John Rizza, Member • DATE DESCRIPTION AMOUNT 1 5-12-93 Pumped Septic Tank $ 14.5.00`' q7- . 4 . yb . Bateson Enterprises, Inc. - Andover, MA 01810 �DOMENIC J. MANGANO — ( ANTONIA A. MANGANO 11 9 1. � 324 BRADFORD STREET NORTH ANDOVER, MA 01845 ??> 1 [ '9h 9h 5-20/110 toR ,C1 f06 $ / r ShaWmUt �� liars e Shawmut Bank,N.A. Boston,MA 07111 F 00 2061: 3 2 i 280 28 211' i"00000 i 0011, i i j I Town of North Andover, NA Watershed Septic System Servicing Report Date: Homeowner: Pumper �kC � Street Address: 1 ( ( Phone -�g i L'( Phone 7 S� Nature of Service: Routine Emergency Observations: Good Condition pO Full to Cover 2��" Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) F Description of Work: Comments: SEPTIC SYSTEM INSPECTION FORM ADDRESS 32 DATE INSPECTED PROPERLY FUNCTIONING? Y N PROPE � . WEATHER CONDITIONS COMMENTS : a RA i ER QUALITY TES l Fb, n lZeSoLTS? . DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name )t+ME11 (C, 2. Street Address — % I s`/ -' v 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool septic tank and leaching area ❑ connection to municipal sewer C other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no X do not know 6. How old is your sewage 4i5posal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years ❑ over 20 years do not know 7.-Has your sewage disposal system been rebuilt or repaired? yes ❑ no C do not know If yes, approximately how long ago? /{-- years. What was done? 8. How frequently is your sewage disposal system pumped out? annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never J�JI 9. Have you had any problems with your sewage disposal system? ❑ yes [ 1 no If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly C odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your�ewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet _ roof/pavement drains shower/bathtub 11. Please state the brand and type (ligWd or,powder) of detergent you use for: dishwasher clotheswasher 12. Does your property have a lawn? yes ❑ no jf,yes, approximately what size? j f less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year R 'C Z�^ Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: V/ ❑ Check here if your lawn is maintained by a professional landscape contractor. ` �r+Hiat_Td d�•�T�',� ya 'il�>ti e1 /rr!.trtil ,-'n^r3 t7 i ...� •, ,, rz�`- , ttiyh� 4Commonw�alth of Massachusetts - - ,: • ity/Town'o NORTH ANDOVER, MASSACH �� ' System Pumping .Record I j j'Form 4 JAN 2 2 2007 DEP.has 'provided this form for use by local Boards of Hea th? IWFSf teniMumping Record must p �.R��rARTMFN i be submitted to the local'Board of Health or other approvi =a thO.i1� - X Facility Information . 1 tmportantt =::-.When filling out 1. System Location: forms on the computer,use only the tab key Address to move your cursor-do not Ci /Town State Zip Code use the return ty . .`. key.,., s . 2. System Owner. Name ' Address(if different from location) CI /Town State i Code City/Town Telephone Number B. Pumping Record , .•..,. ©D 1. Date of Pumping at 2. Quantity Pumped: Gallons 3. Type of system: . ❑ Cesspool(s) l Septic Tank ❑ Tight Tank ❑'.Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System eeGhjWv )Ung C S 6. Sy em Pumped By. Name Vehicle License Number . ,.. 5g..�, � Sf fiord rna. • J Company i osed: ' where c ntents were ds I he o 7: : Location P fH liar ma Date Signature o a . http://www.mass.gov/dep/water/tipprova,ls/t5forms.htm#inspect t5fomm4.doc •06/03 System Pumping Record•Page 1 of 1 1 t ryM.yt(1�tr i 1.i; •i,• OR"T' :A1IDOVER� MA ' e �l.t(J,, .il '•(f .iii",fl'I Irtr !�'JI. �J,1�7r"�4t'�✓✓�� ��i+liu..l.:.' �� MAY 0 � 0 . .:'f.. ,'.��.,.,,���(����;'��I'f��il��,�;:;�,;'�:(, ,,Is;, -,�i,,e',�,•r i+�� , proJldod jhla form for use by local Boardsof He ::ba submlf(ed Q.t8 },.he.local�Board o/ Health or other �tJ�6.7-1i �,_� PARTAnEh�trnMEN :>,.• r.:, ::;;, ::,:y.:.;• :�,��;':,•: '.r., r approvl - A; F ility .Inforri tion 1,.rtW,nan(�unp.out' ..:1', .' System Location;' only Vja tab key Address 094 la mono yew.. '; 'SSI•the• .y T'i•,.,d:i'�;,, /TOY/n ' ,,:; , . I. ...._. ;; � �, retum.l•`, .. ;'.t;.':�';. .• y,',•:i,,, .,':r�: . .. � Stag :','. rk1�''�3;,4j,;;''•`•:• �'Y�(IYV,hi'�'�.' ,il' -, Zlp oda slam owner, 40 c'l;.•,j!., •,,J::.tiy.Jt'i'�fi.'.:`�')`�r/''NIlTI/"'4: `+' (1" i 1,,.� �.., :i'. ;'1:. rSr:1•,1.�.v'„ ''+.�,'.I•Ln � .. i Addroti(I(dlNorintl rem bcaUon) � � CltylTown., Slate 7� 4p Cone !. Telephone Number l t Pump c 9, .,i,/'.ttlq`,;1• �� 7 , �., � ..,� ,�'.;`�:w.' I:i%;{I,I`l,..,,I„r,>..,,:';'I,'{!•,.7t 1,; 'oe Dat�:of Pumping`+ pole 2, Quantity Pumped; �TYG.e P�.ayatem;', '' ❑ Cesspoo(s) Septic Tank ❑ TI9ht Tank ' ,.' ;C�JOther(descrlbe�;•� :.`�' , �iut3ri,t T69 Fllta E sant?.❑ Yes,❑ No i(yes, was It cleaned? -,:. :f, ..;(,'• f.R;' , Q Yes ❑ No vmp .. ... _'�- <>:��..y::.��;�,..',Itn'Y+J'(I':1/.}�%,iJ` I•w I ,ill jl�„1:�,.�' .'•�� \{�r Ir15�l�;i'J'fil',(�'!i)'J1;.6',��ti'��i, lly�r..j,,.�, ...�1 .. .. � ':1. ;'.i' :+''!�:��11'l;i,;:I YIt(.(�4,' ''if/.•I l•�.�r�tJ l,�`,•,.l' , '.: •�.;;�'^;jr �;r S''It ��,," l�' .�x''. Irl r, ,r,� .i i' '�'`�� �'�T. 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