HomeMy WebLinkAboutMiscellaneous - 357 CANDLESTICK ROAD 4/30/2018Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
System Owner & Address:
Ken Connolly
357 Candlestick Road
North Andover, MA 01845
Location of system: Front yard
Date of Pumping: June 13, 2013
Type of system: Septic Tank
Gallons Pumped: 1500 gallons
System pumped by:
Service Pumping & Drain Co., Inc.
5 Hallberg Park
North Reading, Ma
License #: BHP -2013-0098,0100,0765,0096,0097,0099,0101
Contents transferred to: Greater Lawrence Sanitary District
RECEIVED
JUL 012013
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Date: June 13, 2013 Pumping: Technician: AS
This is PROPRIETARY and CONFIDENTIAL information that may
be used only by the Board of Health for regulatory purposes
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
System Owner & address:
Ken Connolly
357 Candlestick Road
North Andover, MA
Location of system: Front
Date of Pumping: August 15, 2008
Type of system: Septic Tank
Gallons Pumped: 1500 Gallons
System pumped by:
Service Pumping & Drain Co., Inc.
5 Hallberg Park
North Reading, MA
REQ
SEP 2 2
TOWNAO HDA,
License #: BHP 2007 0728, 0725, 0727,0722, 0724, 0726
Contents transferred to: Greater Lawrence Sanitary District
Date:Aug°'U% 15 2008— Pump ng�Tq hnic an: BL
This is PROPRIETARY and CONFIDENTIAL information that may be used only
by the Board of Health for regulatory purposes
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
System Owner & address:
Ken Connolly
357 Candlestick Road
North Andover, MA
Location of system: Front
Date of Pumping: May 10, 2007
Type of system: Septic tank
Gallons Pumped: 1500 Gallons
System pumped by:
Service Pumping & Drain Co., Inc.
5 Hallberg Park
North Reading, NIA
License #: BHP 2006 0680, 0750, 0751, 0752, 0753, 0754
Contents transferred to: Greater Lawrence Sanitary District
RECEIVED
MAY 2 2 2007
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Date: May 10, 2007 Pumping Technician: BL
This is PROPRIETARY and CONFIDENTIAL information that may be used only
by the Board of Health for regulatory purposes
This certifies that .C7!1.... ..' . ................
has permission for gas installation ............
in the buildings of ........ .
at �North Andover, Mass.
Fees.. Lic. No.. L'....; .ca-,,-...-...... .
GAS INSPE6f0R'
Check #
571
Date .. O� ...........
NORTI,
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .C7!1.... ..' . ................
has permission for gas installation ............
in the buildings of ........ .
at �North Andover, Mass.
Fees.. Lic. No.. L'....; .ca-,,-...-...... .
GAS INSPE6f0R'
Check #
571
MASSACHUSEYIS UNIFORM APPLICATONFOR PERMITTO DO GAS FITTIN
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations
New Renovation
Owner's Name
Replacement ® Plans Submitted ❑
Permit # &D?/
Amount $ '�,?v
(Print or type C e one: Certificate Installing Company
Name �f Corp.
Address ` ® �'❑ Partner.
usiness Telephone ❑ FimVCo.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE V Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑
If you have checked yes, please indic he type coverage by checking the appropriate box. ❑
Liability insurance policy Other type of indemnity ❑ Bond
Owner's Insurance Waiver:. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installation Orme nder Pe for this application will be in
compliance with all pertinent provisions of the Massachuse�Yl�e Gas C d ant 142 the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Plumber
Journeyman
1ST. FLOOR
7TH. FLOOR
(Print or type C e one: Certificate Installing Company
Name �f Corp.
Address ` ® �'❑ Partner.
usiness Telephone ❑ FimVCo.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE V Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑
If you have checked yes, please indic he type coverage by checking the appropriate box. ❑
Liability insurance policy Other type of indemnity ❑ Bond
Owner's Insurance Waiver:. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installation Orme nder Pe for this application will be in
compliance with all pertinent provisions of the Massachuse�Yl�e Gas C d ant 142 the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Plumber
Journeyman
System Owner & address:
Ken Connolly
357 Candlestick Road
No. Andover
Location of system:
Date of Pumping:
Type of system:
Gallons Pumped:
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
Front yard
',A 3 0 2003 ,
May 13, 2003
Septic Tank "
1500 gallons
System pumped by: Service Pumping & Drain Co., Inc.
License #: 109-20H
Contents transferred to: Lawrence Treatment Plant
Dater ' May 13, 2003 Pumping Technician: MF
This is PROPRIETARY and CONFIDENTIAL information that may be used
only by the Board of Health for regulatory purposes
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record TOWN OHEAF
System Owner & address: r � �t��
Y
Ken Connolly OCT r 22003
357 Candlestick Road
No. Andover
Location of system: Rear yard
Date of Pumping: 09/17/2003
Type of system: Septic Tank
Gallons Pumped: 1000 gallons
System pumped by: Service Pumping & Drain Co., Inc.
License #: 109-20H
Contents transferred to: Lawrence Treatment Plant
Date: September 17/2003 Pumping Technician: SD
This is PROPRIETARY and CONFIDENTIAL information that may be used only
by the Board of Health for regulatory purposes
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System Owner:
Ken Connolly
357 Candlestick Road
North Andover
FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
System Location:
front yard
Date of Pumping: October 21, 1999 Quantity Pumped: 1500 gallons
Cesspool: No /X/Yes /—/ Septic Tank: No i-1 Yes /X/
System Pumped by: Service Pumping & Drain Co., Inc. License # 636
Contents transferred to: Lawrence Treatment Plant
Date: October 21, 1999 Pumper: M.F.
This is PROPRIETARY and CONFIDENTIAL information that -may be used
only by the Board of Health for regulatory purposes.
15
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COMMON OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PR,OTECTIOfi
ONE WINTER STREET. BOSTON. NIA 02108 617-292.5500.
WILLIAM F. WELD
Governor
ARGEO PAUL CELLUCCI
Lt. Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ft 4M"
PART A
CERTIFICATI N
Property Address: `35 � Ctu�.. � �`'` Add�es9 of Owner:
Date of Inspection: ' �a — ` of different)
Name of Inspectors
1 am a DEP' pro edsystem inWctor pursuant to Section 13.UO of Title 5 (310 CMR.13.000)
Company Name:
Mailing Address: I t 1 i
Telephone Number:
cD♦
TRUDY COXt
Scm*tw%-
DAVID B. STRUHS
Cbfiimissioner
CERTIFICATION STATEMENT
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 sewwaa disposal systems. The system:
...t/ Passes
Conditionally Passes -
Needs Further Evaluation By the Local Approving Authority
_ Fit
f
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days bf completing this
inspection. If the system is 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. The original should be sent to ", Iysterh owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, C, of b
AI SYSTEM P
�t found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The. system. upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of deteirmination in All instances. If "not determined"$ explain why tion
The septic tank is metal, unless the owner or operator hat provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank Was installed .within twenty (20) years prior to the date of the inspection; or
the septic tank; whether or not metal; is cracked, structurally trtisound, shows substahtial -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
ank
as approved by the Board of Health.
(rravisod 04/35/97) Prigi.± e! Sb
DEP on the World Uncle WMD: http:/hAvW.mfpnet ft te.1n$.UWdep
Printed on Recycled Paper
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION -FORM
PART A
CERTIFICATION (contihued)
Property Address: `?� S �] CCLA-^a, Q_94-1(,, AC. 1 v JlA2
Owner. 140 AA -12--S
Date of Inspection:
.,�
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box it 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). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed-pipe(s). The System w4.1 pais
inspection if (with approval of the Board of Health):.
broken plpe(f) are replaced
obstruction is removed
CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ,..
Conditions exist which require further evaluation by. the Board of Health in order to determirse 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 ISNOT 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE`
ENVIRONMENT:.
_ The system has a septic tank and soil absorption .system (Wyand the SAS is within 100 feet to a surface water supply or
tributary to a surface Water supply.
_ The system has a septic tank and soil adsorption system and the SAS is within.a Zone i of a public water supply well:
_ The system has a septic tank and soil absorption.systein and the SAS Is within 5b feet of a private w,ate: supply moll:
The system has a septic tank and soil absorpti6h, system And the SAS is less than 100 feet but 50 feet of more from a
private water supply well, unless a well water ahalysis .for coliform bacteria' and volatile organic compd6nds Iridioates that
the well is free from pollution from that facility_ and the presiertbe of acrimonia nitrogen and 'nitrate hititgehi, is Equal to or.
less than 5 ppm. Method used to determine distance �;, (approxitnatlon .riot itilld). `
3) OTHER
(revised 04/29/97) Pali 2'b! 10 .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION. FORM
t PART A ,..
CERTIFICATION (continued)
Property Address:
Owner: VV1� r
Date of Inspection: t £
D] SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15:303. 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.
Yes No
_ 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 6f the ground or surfaceTwaters due to an' overloaded or clogged SAS or
cesspool.
_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool'
Liquid depth in cesspool is Jess 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
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Anyportion of a cesspool or privy is within 100 feet of a surface water supply or tributary io a surface water supply,,.
_ r _ Any portion of a cesspool or privy Is within's Zone I'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 froFn a private water supply weN with no
acceptable water quality analysis. If the well has been anaWod to be acceptable, attach copy of we11 water analysis for
coliform bacteria, volatile organic compounds, ammonianitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 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: .
Yes No .
the system is within 400 feet of a surface drinking wate"f supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area (Interim Wellhead Orotection Ares > IWPA) of a mapped Zone)l of a
public water supply well)
The owner or operator of any such system shall bring the 'system and facility into full compliance with the groundwater treatment program
requirements'of 314 CMR 5.00 and 6.00. Please consult the local regional office of the beo anent for further information.
(revised 04/25/97) t?agi 3 69 t0.
Ptd f o! 10
tsqivieod 04/2S/97t
SUBSURFACE SEWAGE DISPOSAL_ SYSTEM INSPECTION FORM
. ' PART B
'CHECKLIST
Property Address;
.y. < 8% ,. A/ ° A &A,
H-o S
Date of Inspection:
Check ifthe following have been done; You must indicate either "Yes" or "No" as to each of the following:
Ye;
Pumping information was provided by the. owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates -'during that period. Large volumes of water have not been introduced into the system recently or
/A
part of this inspection.
s � �j1�,. ,n rj yti0 � u1-�'v
Note if not with N/A.
As built) ns haJle been obtained and examined. they are available
w
The facility or dwelling was inspected' for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_
,The site was inspected for signs of breakout.
A1) system components, :excluding the Soil Absorption System, have been located on the site.
The 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 liquid, depth of sludge, depth of scum.
The.
size and location of.the Soil Absorption System on the site has been determined based on:
The facility owner _(and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System..
Existing information.' Ex. Plan at B.O.H.
_
Determined in.the field lif any of the failure criteria related to Pan C is at issue, approximation of distance is
unacceptable) 115,302(3)(b))
Ptd f o! 10
tsqivieod 04/2S/97t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
FART C
a SYSTEM INFORMATION ,
'
Property Address: `35�`I l �cJ`i'K�..��� . A uei('.
Owner•.
Date of Inspection':
n nW rnNnirinNC
RESIDENTIAL:
Design flow: 15-0 g.p.d./bedroom for S.A.S.
Number of bedrooms:,
Number of current residents: a
Garbage grinder (yes or no):g
Laundry connected to systeT (yes of no):�S
Seasonal use (yes or no): NO I
Water meter readings, if available (last two (2) year usage (gP�d):
Sump Pump (yes or no): Q.% 2►6��'�?�}3x7.S: �9ttj$2?- C' G3
-
Last date of occupancy: . e /�.�a =S ae/
COMMERCIAUINDUSTRIAL:
Type of establishment: `` ,•
Design flow: gallons/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:
P
System pumped as part of inspection. (yes or no) e5
If yes, volume pumped, US -CO �¢alfo��ns"" 1� M�
Reason for pumping: t %) ?.G'� "t ACL _
TYPE OFYSTEM
(Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy �..
Shared system (yes or no) (if yes, attach previoUs inspection records, if any)
VA Technology etc. Copy of up to date contracts
Other
APPROXIMATE AGE Of all com nests, date installed (if known) anis Source f inforinatron:
�, �sV\'
Sewage odors detected when arriving at the Site: lyes or no)
(revised 04/=9/97) tie io"
f,
i
is
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
[late of Inspectiont
BUILDING SEWER:✓
(Locate on site plan)
4
Depth below grader / �� p
Material of construction: +mast iron A j'o PVC ._ other (expl 'n)( '{.3 G
rf �
Distance from private water supple wen or suction lire e -
Diameter_
Comrpents (c9nditiop of 'oints, venting, evidence of leakage, etc.)
SEPTIC TANK:.!/ -
(locate on site plan) alI�-pip_
Depth below grade. �� l �� 14 t
Material of construction: _ 5ncrete ,_metal _Fiberglass _Polyethylene _gther(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance = (Yes/No)
i
Dimensions: RO N57'x
�r h% •� /a.�.e:
Sludge depth: _T r�
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: V " I? e r
Distance from top of scum to top of outlet tee or baffle: It
Distance from bottom of scum to bottomof outlet tee or baffle: ad --�Q ��(�
How dimensions were determined: ++z"�' ��►�"�' .�.s1t��.. (4� v
Comments:
(recommendation for pumping, condi" of inlet and o tlet tees or foes, depth of ii uid level i rel tion o outlet
integrity, evidence o�akage, etc,) G u. �� s _
GREASE TRAP: hQne-
(locate on site plan)
Depth below grade:
Material of construction: _concrete _,metal _Fiberglass _Polyethylene ,_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet fee of baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: £
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees br. bsfflesj,depth of liquid lintel i i relation to outlet invert, structorai
integrity, evidence of leakage, etc.)
..
(reviaad 04/2510) ta9i Mo!'t0
4
SUBsUREACE SEWAGE DISPOSAL �VSTEM INSPECTION FORM
PART C
s f SYSTEfN IfVFOkMATION'ftontinued)
Property Address:
Owner: 49t �e
Date of Inspection: *�
^' � cam•-^.•r��1i
TIGHT OR HOLDING TANK:�—Ke-frank must be pumped prior to, or at time; of Inspection)
(locate on site plan).
Depth below grade:
Material of construction: _concrete _metal.Fiberglass_Polyethylent ipther(ettplain)
Dimensions
Capacity, gallons --
Design flow: gallons/day
Alarm level: _ Alarmin working order Yes; No
Date of previous pumping:
Comments: `
(condition of inlet tee, condition of alarm and float switches, etc.),
1 -
DISTRIBUTION BOX:`
(locate on site plan)'
Depth of liquid level above outlet invert:
Comments:JE
al evidence of solids r ov t ev)d nce of leaks a itito or out of x; tc.)
(note if level and distributiprl is eqN_ , — _ � N �. Ir g �°. _-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM
PART C 1
SYSTEM INFOWATION (continued)
Property Address:
Owner:
Date of Inspection: CL `
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation dot required, but may be approximated by non -intrusive .methods)
If not determined to be present, explain:
Type:
leaching pits, number._
leaching chambers, number:
leaching galleries, number:
leaching trenehes, numbst,length:
leaching fields, number, dimensions:
overflow cesspool, number: .
Alternative system:
Name of Technology:
Comments:
(note conation ofsoil,signs of hydraulic failure, level of ponding; condition of vegetatit)tt; etc.)
c V1 ;
CESSPOOLS.
(locate 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, signs of hydraulic failure, level of ponding, tondition.of vegetation, etc)
PRIVY: Vim,
(locate on site plan) -
Materials of construction: _-- Dimensions:
Depth of solids:
Comments: '
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetatl* etc.
(revised 04/25/97) t+agrt li eY id
ri
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
s A
Property Address: 3
Owner:
Date of Inspection: 1 VV\
Depth to Groundwater 4 Feet
Pleaseindicateall the methods used to determine High Groundwater Elevation:
I' Obtai ed from Design Plans on record
r' Observation of Site (Abutting property, observation hole, basement sump etc.)
D.ettermine it from local conditions
i ----Check with local Board of health
Check FEMA neaps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
GLS xcx)
TEL! (508) 475y1474
1 FAX: (508) 475-5451
BATESON ENTERPRISES, INC.
Excavating - Water & Sewer Linea - septic Systems & Pumping Service
11 'I Argilla Road . Andover, Mass. 01810
Title 5 Inspection Report
"1,424—
Property
Owner: -----------------------------
Date Of Inspection: ----------------
My report contained herein does not constitute a guarantee
of future usage and the functionality of the existing aept•�c
system. Such report issue6 herewith is merely based upon ftly
observations, and I hereby disciaitti any further operation
of your current septic system,
d
y
Neil 4. hateeon
Bateson Ehterpr.igeis Inc►
ii of 11
System Owner:
Ken Connolly
357 Candlestick Road
North Andover
FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record
System Location:
front yard
Date of Pumping: May 31, 2001 Quantity Pumped: 1500 gallons
Cesspool: No /X/Yes / / Septic Tank: No / / Yes /X/
System Pumped by: Service Pumping & Drain Co., Inc. License # 109 -OOH
Contents transferred to: Lawrence Treatment Plant
Date: May 31, 2001 Pumper: M.F.
This is PROPRIETARY and CONFIDENTIAL information that may be used
only by the Board of Health for regulatory purposes.
System
Ken Connolly
357 Candlestick Road
North Andover, MA
ss:
Location of system: Front yard
Date of Pumping: April 07,2005
Type of system: Septic Tank
Gallons Pumped: 1500 Gallon(s)
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumping Record I pt—" ` irn
System pumped by: Service Pumping & Drain Co., Inc.
License #: BHP -2004-0977
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RECEIVED
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Contents transferred to: Greater Lawrence Sanitary District
Date: April 07,2005 Pumping Technician:AM
This is PROPRIETARY and CONFIDENTIAL information that may be used only
by the Board of Health for regulatory purposes
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
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Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. Other
information must be substantially the same as that provided here. B1
local Board of Health to determine the form they use. The System P
the local Board of Health or other approving authority.
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firms may be used t the
ore u i. S_ ith your
I, _ must be submitted to
A. Facility Information
1. System Location: Left fro , eft rea) left sid of house. fight front, right rear, right side of house.
Address�v 516�,`,�
CitylTown State
2. System Owner:
Name
Address (if different from location)
Cityrrown
B. Pumping Record
1. Date of Pumping
3. Type of system: 0
C) Other (describe):
Zip Code
State /o Zip Code
Telephone Number
7�
('a-(-e�&
2 Quantity Pum ed'
Date p Gallons
Cesspool(s) _ eptic Tank Tight Tank
4. Effluent Tee Filter present? [] Yes [lNo If yes, was it cleaned? [] Yes Lj No
5. Condition
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6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
lL.S: � Lowell Waste Water
F 5821
Vehicle License Number
of Hau r Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumpinz Record
System Owner & Address:
Ken Connolly
357 Candlestick Road
North Andover, Ma
Location of system: Front
Date of Pumping: May 6, 2010
Type of system: Septic
Gallons Pumped: 1500 gallons
System pumped by: I MAY R 19910
Service Pumping & Drain Co., Inc.
S Hallberg Park
North Reading, Ma
License #: BHP -2010-0359,0373,0374,0375,0376,0377,0378
Contents transferred to: Greater Lawrence Sanitary District
Date: May 6, 2010 Pumping Technician: BL
This is PROPRIETARY and CONFIDENTIAL information that may
be used only by the Board of Health for regulatory purposes
�)yste :i caner
Kew CoI/I 110 l�
system ocation
Type. '• Emergency ❑ Routine A.
❑ S� nk:, No ❑ Yes
Cesspc •�I: No [I Yes tic Ta
Sip
tic
9-7—// Quvtiry Pumped: 1,x08 gallons
Date c Pumpine: .. —
I:SORACZEK Permit
r.
Svste. Pumped by (Company): - i
Contc -.ts transferred to:
`Cont:.ius disposed at:
G1S
° pumper Si
Dave.' � Pump eattiren
Condition of system other comments:
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