HomeMy WebLinkAboutMiscellaneous - 345 BOSTON STREET 4/30/2018 (4)I
Commonwealth of Massachusetts
ro City/Town of RECEIVED
System Pumping Record NORTH ANDOVE
Ju Form 4 ,t 9 2013
DEP has provided this form for use by local Boards of Health. Other forms ma 'b TO .r fttAC�1f>t
information must be substantially the same as that provided here. Before usin
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 on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
1. System Location:
3 -
Address
City/Town State Zip Code
2. System Owner:
/yam At O
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system:
State Zip Code
G/7 X74 77 -
Telephone Number
3/moo C -
Date 2. Quantity Pumped: Gallons
❑ Cesspool(s) 0�eptic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No
5. Condition of System:
Sts a/c
If yes, was it cleaned? ❑ Yes ❑ No
6. System Pumped By:
1l Vehicle License Number
ame
G.L.S.D.
Company Orth Andover, MA.
7. Location where contents were disposed:
Signature of Hauler
Signature of Receiving Facility
Date
Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
Location 3r 0• �� A
No. 17V Date 1-1111q-017
�aRTM TOWN OF NORTH ANDOVER
Y 0 1+
P
` Certificate of Occupancy $
cHustt Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
04,
TOTAL $ 10'r
Check # lJ.3as20
19943
Building Inspenr
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 174 (2/1/2006) Date: January 18, 2007
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 345 Boston Street
MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE
WITH THE PROVISIONS OF THE'MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Litchfield Co. Inc
26 Ray Ave
Burlington MA 01803
Building Inspector
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APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
Building Permit # / TV
ADDRESS/LOCATION OF PROPERTY :,3u 6-T LG+ 102
Map Parcel Lot Number /off
SUBDIVISION ZoStv.,J s%
DATE REQUESTED FILED/READY FOR INSPECTION / "/% 0 e7
-
CLOSING DATE ON PROPERTY: /3, 1--),
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES.
SIGNED
CONSERVATION
PLANNING
DPW - WATER METER
ROUTING
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SEWER/WATER CONNECTION
NOTE
0PW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THEOCCUPANCY/INSPECTION REQUEST
DPW 44- wamul
Signature
Fle: OC form revised 2006