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HomeMy WebLinkAboutMiscellaneous - 34 BOXFORD STREET 4/30/2018 (3)Form 4 -- System Pumping Record Commonwealth of Mossaehusetss Massachusetts System Pumping Record Owner P. Type: Emergency Routine Cesspool: No Yes yt Date of Pumping: �/�'✓�- O 3 System Pumped By: Wind River Enwronmento% LLC Contents transferred to: n Location Contents Disposed at: : L�l Date: y-- 3 -- 0 3 Pumper Signature: ►C• rvi Condition of System other comments Dep Approved Form - 12/07/95 Septic tank: Kb =Yes Quantity Pumped: /,'UO Gallons Permit #: z "1 Q V, d 5L M M T —T FF I C j 'F3 I C ffl � O - Q C € O C c t F O G c o � m y� r E Q. rt L i a r: C O L O 'w C O cc 2 u CL If 'E O If O �1 ate-+ C1 = 1 N W V .0 f0 0 0 Q �a- O co O m 47 I � Ql a a O Q O Q >r c - co O E m O U O D C U •A C O U O 0 � � CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 SYSTEM OWNER: q L <�A- v, FORM 4 - SYSTEM PUMPING RECORD SCOMMONWEALTH OF MASSACHUSETTS / " r 0-1 d1v ✓ E , MASSACHUSETTS SYSTEM PUMPING RECORD 44 L't �06;1-3 _ yi93 SYSTEM LOCATION: (� -�L4��s DATE OF PUMPING: LZ/ /9/6c, QUANTITY PUMPED CESSPOOL: NO ff7YES a SEPTIC TANK: -5c3 LN GALLONS NO 0 YES 0 - SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: C--:-6 L SJ DATE: A �O /6 `, 9 INSPECTOR: i� l r ThE PKQeE,6Zi1Q AL EXPEFil6 IN THE SEPIC AND \t, DRAIN INDLSTRY 0? ,o 5 55 .. FORM 4 - SYSTENI PUMPING RECORD Commonwealtb of Massachusetts Massachusetts Pumviner Rey System U Amer 5ystet Location 1 z �(I�- U4�Fra Dale of Pumping: �� S� — rr Quantity Pumped: ��.GG�gallons .'Cesspool: 1\0 Yes ❑ Septic Tank: No ❑ Yes /� b SystemPumped b\ . ....................:............................................I........ License, #:................................................................... Contents transferred to: Late Inspector ,tem Owner S2V11. '! Cly.) 4Lr5 %4 ll-.Nxtotrt ,,.treet: rar) t.'1 Anao-ver, ;,Yt, U;.641) (�)"lO)- vt-..s- 41 9 .. Type: Emergency Cesspool: No Date of Pumping: C) C;"— Commonwealth of Routine Yes System Pumped By: Wind River Enwmmmntal, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumpr Signature: (,-�p Form 4 -- RECEIVED JUL - 9 TOWN OF NORTH HEALTH DEPAI stem Location (SS S ! - 6 8 3 Dep Approved Form - 12/07/95 Septic tank: No =Yes ©/ Quantity Pumped: 15Op Gallons Permit #: A-- C AA- A s 11V 6X' o D 10Z A A./ /C 177 FC� 55S, 3.3 -� -G Y //Y yAi z ow A -A--.9 wr 7,y, .//t/ 1'/ '0., ? / FC� O 40, 1 S�Q I tt t, Ir i t � o i a Low Ir � s . V i 1r t t� TO: NORTH ANDOVER, MASS 2 / 19 7 ;1 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at L Z-16cy�`�,0A D ST- North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 . d . P�f.'E n S� eg.�nitarian a yd'�Of o��/` r SOIL PROFILE & PERCOLATION TEST DATA Town/ C' ty No.&Stree t 1120,Y)e-e/ Lot No._� Loc./Subdiv. Plan OwnerCl•-/Ge v Investigator0 Observer O SOIL PROFILES -DATE 1' lev. 2i Elev. v 0 7 7i 3' Elev.� -L--Elev. 0 0 0 2 3 4 5 6 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 10 I 10 �( 10 �� 10 Benchmark Location Elevation Datum Percolation Tests -Date -41.7177 Pit Number 1 2 3 4 5 Start Saturation �� 3 Soak -Mins. Start Test -Time Drop of 3" -Time • ¢7 Drop of 6 "-Time ; 5 7 Mins.lst 3"Dro r►,,.� Mins . 2nd . 3"Dro l���e5 & z)xetcnes on Back Frank C. Gelinas & Associates, North And. r a . n O 1Q.-1�P.'d 3 za"l - e"C WELL DATABASE ADDRESS: AGE OF WET � T : ?. WELL DRILLER: � WLLIL PE.� rLT, WELL LOCATION: — WELL PE��tiILT' DATE: ? DE 7H OF WELL: "-TYPE OF WELL: a._ DRILL= b. DUG C. U FKIICI�i0 i TYPE OF WA2ERBE`4RING ROCK: WATT ANALYSISDATE= - -- Z EtICH MAN ESE:. Y N -_ F�LGIKON: Y N OTFIER CONT �{ N =--77 V= DATABASE ADDRESS: ��/ - i AGE OF WELL: WALL DRILLER: "WELL PERI T: WELL LOCA WELL. P'-=�ET DATE: DEPTH OF WELL. � TYPE OF WELL: a— D LED � b. D.L1G c. UNKNOWN TYPE OF WATER BEARING RO WATER ANALYSIS DATE: HIGH MANGANESE: Y N HIGH IRON: Y N g" OTH-LER CONTAiNC ANTS: Y N t NORTH ANDOVER BOARD OF Hk,4LTH INSTALLATION CHECK LISW _ APPROVED -�� DISAPPROVED �, EXCAVATION OK Date: Date: -: /j -Zit--7 7 r � ...A Reason: . 1 . 1. As Built Submitted Check: Lot 1 cation, dimensions, of system, location in regard to per olation tests, depth of system, i -rater table r 2. Distance to LTetland Areas,. Drains, Street & House, Drainage Easement and Wells. 3. W er Line Location 4. No PV ipe 5. Septic Tank - ees, nent-Pipe to Tank.Jo s on both side of Tank. 6. Distribution Box - No cracks 'n box or cozier, all otic e ly from box. 7. Leach Fields - Dimensions, Stone Depths, Capped ends, Clean double -trashed stone Leach Pits - Dimen ons, Dept f Sto. joints on both sides of 9. io Garbage Disposals 10. Final Grading 4,barricading of sub -surface system) d w ni I I . 9 ��o I It �n e -s j v