HomeMy WebLinkAboutMiscellaneous - 4 Saile Way C
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TOWN OF _FORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER&ADDRESS SYSTEM LOCATION
(example_ left,front of house)
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earn ��t�.
5 /r&� /t o r -!� �� —_ &F
DATE OF PI 11fPiNG:.��J —/,,2 UANTJ'FY PuINIPE-D GALLONS
77—
CESSPOOL: NO
XES SEPT:t;S: TANK, NO /"YFIS
N,'tTURE OF SERVICE: ROUTINE EMERGENCY
OBSER VA LIONS:
GOOD CONDI'I'YONFULL TO COVER
HEAVY GREASE � RAFFLES IN PLACE;
ROOTSLEACHFIELD RUNBACK
EXCESSIVE SOLIDS �— FLOODED
SOLIDS CARRYOVER _ OTHER(EXPLAIN)
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IlUA�IX
COMMENTS:
CONSENTS TRANSFEILRED TO:
—14
UEC - 7 2001
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 2 7-D l
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S SY TEM
OWNER&A�d]►I�ESSf---- § S' fAf LOCA fl�Ol�i
4 Cay ` (esa p�leleft
it���rocnt o house)
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1
GATE OF PI 1�€PING:/D- f•�►N F ' I`L': ll'ElG+ V _GALLONS
CESSPOOL: NO ✓ YES SEPVC TANK: NO � YES
NATTJRE OF SERVICE, 'ROUTINE EMERGENCY
OSSLRVArIONS:
GOOD CG,TAPT oN- FULL TO COVER
HEAVY GREASE � RAFFLES IN PLACE
ROOTS LEACHFIFELD RUNBACK �—
EXCESSI''E SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
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U/J T-N
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COMMENTS-
CONTENTS TRANSFERRED 'Y'O: !
Date.�:. .! ... ...........
NORTH TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
a S
CMUSEt�+
This certifies that . . . . . . . . . . . . . . . . . . . . . . . ... .'
has permission for gas installation . . . .�. . .. . ; .. . . . . . . . . . . . . . . .
, H
in the
//buildings of :. . . :.: : `' *? . . . . . . . . . . . . . . . . . . . . . . . . . . .
at .7 ... . . . ... . . . .c'f '. . .':'"� . . . . . . . ., North Andover, Mass.
Fee.iZ�. . . . . . Lic. No//, . . . . �!�.'. . . . . . .
v. . ./ GASINSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
3 >
MASSA ; 1 APP CATON FOR PERMIT TO DO GAS FI.
Type or print) PARCEL Date 2 — / O d
NORTH ANDD
Building Locations :Z _ tea, �C �,(��_ Permit 4
Amount S
A,,9 j f Owner's Name I l jo Jd7
�r
New Renovation ❑ Replacement ❑ Plans Submitted ❑
1
nrn A G Z _
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cn
SU B-BASENI E :NTBASEMM ENT
Is'r. FLU O R
2ND . FLOUR
3R 0 . FLOOR
1"r ti . FLUO R
ST H . F L U O R
6T N . F L O O R
7T 11 . FLUOR
s,r 11 . F L O O R
(Prin. )r type) Check one: Certificate Installing Company
Name X3 Ja- /r11Corp.
kJ
Addre`s 00.10 e-%7—,r C �armer.
/L,11(itC I"Vi`Td^, a3C,3 3
Business Telephone ❑ Firm/Co.
Name of Licensed'Plumber or Gas Fitter " - k -f � ?Aj"•gyp
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes EEr No❑
If you have checked ves•please indicate the 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 ED 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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State as Coe C er I >2 of the General Laws.
By: Signatu f Licensed Plumber Or Gas Fitter
Tide ❑ Plumber »lo 3
CityiTown ❑ Gas Fitter LiCense i umoer
Master
APPROVED(OFFICE USE ONLY) r7 Journeyman