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Miscellaneous - 45 INNIS STREET 4/30/2018 (3)
45 INNIS STREET _ I, 210/098.C-0050-0000.0 i I _ a Commonwealth of Massachusetts R CE1 D _ City/Town of North Andover System Pumping Record SEP U 2 2014 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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: on the computer, —( � use only the tab � I key to move your Address cursor-do not North Andover Ma 01886 use the return key. City/Town State Zip Code 2. System Owner: zbm Name emm Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: GallonsUlf 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 clearied? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: 4kdJ 14 r s Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record.Page 1 of 1 Commonwealth of Massachusetts = City/Town of No Andover ---� a System Pumping Record �'�' ����" Form 412 2313 M "I SL-1 DEP has provided this form for use by local Boards of Healt Qthert;for s-m yabe\use , but the information must be substantially the same as that provided erigFB'efdr€�a-cif"igrthiklfor: , 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: on the computer, 1 ��1 use only the tab 4 .-,-- key to move your Address cursor-do not No Andover Ma use the return City/Town key. State Zip Code 2. System Owner- Name wnerName rcnon Address(if different from location) City/Town State Zip Code Telephone'Number B. Pumping Record \M0 1. Date of Pumping ate 2. Quantity Pumped: 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 5. Condition of System: 6. Systemr"m ped _ \ Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: wart's Pre-tr Ont Plant, 20 So. Mill Bradford, Ma 01835 1 ignat Date Signatur of Receiving Faci i y Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts W City/Town of No. Andover System Pumping Record Form 4 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 45 Innis St only the tab key Address to move your No. Andover Ma cursor-do not y use the return City/Town State i key. 2. System Owner: AUG -5 2011 r� Hannay TOWN OF NnFjT�j Name HEALTH DEPARTMENT 'ef07 Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record '-)/2q IIon 1. Date of Pumping Dae ( 2. Quantity Pumped: 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 5. Condition of System: yste mPumped By: CA1 Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: FS t art's Pre-treat t Plant, 20 So. Mill Bradford, Ma 01835 I Signatur f Ha r Dat Signature o Rec ' ng a lity Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 ORT AYl1D0VER • MAS SAC USE I Record DEP hai provldad ;h4 a auorr,I�Sod to the lova; Scar;: c'r nau:,n �, ��y�toa�;r Tt9,© a = _ C •,ar apr.rOvin ,y�; n�j• A, FacIII Inforr)'ation 5y5.9m LUon:74 �•� . o ��ray � �.res� c: oo•dei — / — s� �M nwm Y; ', ChY/Town �I 3 am .'Fv '.y,. .Il.,.,�� f�dre� (1I4Ufor�n! rcvn hc�Ucn) • B,':PumPing Re��ord — .. 1• t.' Cats o! Pum Inp' 3. TYP9 of syala`m .• ❑ asspoo�(s) optic TanKT Tich anF. ' ,n'�0'har (describe,. -- • 4 Effluanl Too FWe( prpsenl? r Yos r\'c yes• as ;,aanad? Y ' es . . `•6,�1';Coridi�lori'Qf,BY;�'m'�'�- ' • 6. Sy ��p P��mpod By: ,. ' ,:' y un♦ w ;�;;,; �'1 ',ti)�;; ; ,I,1; nVohlce �Y:�..l •Y 1.I��n�)•r`�%j•yN;��C..:.C� �!• � r `�� r .j. ,,:� '�'. � ! �1 - � � .t�•r/•��.�'6�ti�/ ��,`�f.,r, Ton !where oonlarits'wara cl,posed: '�:r��r{w�.mess,gov/de;.Jwafa�/approvaJs/�6lorms•h,T.a;�9�ec� ./ 1s ;P^ r OVER MASSA CHUSET- \ Kr: I,��I,YfI�f; ,r�i /.yt lry:i l4,v/'(' 11 'i,V". I7QhliP/OYIdId hlJ I% ,. .J,O, r 9010 Of IQCII aOI/C �Crpnp��,f;nOCOorr Calvnevrr rA01 r. I•.InOrrryCCEIVEnn !0.1, A. Facility Inl OCT —0 -6 2009 Sys vm locavw, TOWN OF NORTH ANDOVER •„4' HEALTH DEPARTMENT L4,- 94, as v>♦ rl f;,m'•;I; CItq/( 1 �< W r .f ,r,, r ,a I, • ' �•.,, 1 '�''��ilti'�''Z,'�'`�Salem Own'er,'��'-%•;,'. .� ' : . , , •1 y�,,°:.,�,'%•,I!.rtl.'•lar;.'I'�''''•�1�,:r r.;•1 r. �r����'^� !' ~' ': 'tiddl►►J (I/Q '111A1 Ja'n"vqn% t .., J��r9nonl ri.mv„ — ;%61vP,lvmp1n8;Ra'gord , type 91 iyJ►om;`.;' L •,• ,, ;,, ,.1•�,• ,,,• $9pl!C Tens , :"y;;r;+1Em�enllTOr (, �(.R,J0n? Y0� No I 1 r6'. .. ..y., '!r��• H.Q�'fVr1jr/r •� 1 �• °.� il'1.11 II•'r'/.+Ir'r.�•rr;�';II'lil✓ �• ry 4'r: Sy Pumped n',.,r. V4 ID SJ.�OYId 1 ' OP 9,Y8)V(01orm),r,,naln»ocl �Jlr Commonwealth of Massachusetts RECEIVE ?`C1ty[Town(of NORTH ANDOVER MASSAC US TS System Pumping Record . 2006 �..,Form 4 • TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. The System Pumping Record mu: be submitted to the local Board of Health or other approving authority. A. Facility Information - Important: When filling out 1. System Location: ` forms on the computer, use 7' only the tab key Address --__.....__ ....._ _.. to move your cursor•do notuse the return City/Town State Zip Code key. 2. System Owner: U - Name Address if different from location) ------ City/Town State '--- ---- -- - Code Telephone Number umping Record - -- Date of Pumping Date -- 2. Quantity Pumped: Gallons ype of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): ---__—__.----_.-_-_-_._._____—._---_--...-------•--.--------- 4. Effluent Tee Filter present? E] Yes No If yes, was it cleaned? ❑ Yes ❑ No r 5. Condition of System: � 6. Sy em Pumped By: ame Vehicle License Number Company 7. Location where contents were disposed: ,Arna Si aturn of Hsu _---..._._ .._.._...__. Date ....-----------------•---- -.._.. http://www.mas4;gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record Page i of IREE,CEf . . SYSTEEm PumplNo P - 7 2005 UAI'k (� O . TOWN OF NORTH ANDOVER TOW :: RK 't ADD SS � HEALTH DEPARTMENT SYS' EM LOCATION -..-.._.__ ._. � i t ��5 I Allo, Wille&ov DATE OF PLJko;�. �QuANnTY Pu&rp6o /oao... yF 'IBA YY C)aE`A3S BAYYLB3 IN PLALt. ROM _ LBACfQj&LC) KLNHAC K 5XC8331VE SOLIDS TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD �l STEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) s U \"I'E OF PUMPING: QUANTITY PUMPED �J�a CALLO', C. I.S ' LN YES SEPTIC TANK: NO �ES �I'UU : 0 NATURE OF SERVICE: ROUTINE EMERGENCY OH.S 'RV.;\TIONS: GOOD CONDITION FULL TO COVEIZ HEAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER 04HEIZ (EXPLAIN) i �1 E`M PUMPED BY: Y, / r Cum.hylENTS: (J:NTEN'I'S TRANSFERRED 'T'O: RECEIVED TOWNOrRTH ANDOVE : SEP - 7 2004 TOWN 01 NJR ell S/ SYSTEM P I 61 , PINQ RECORI-) DA FE (z TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM OWNEzR SS t SY 'm LOCAMN Alle). �� DATE OF PUMPINO: ---..,-.,..-Q[,IANTFTY PtJMPED:, CLSSPOOL: NO YES SOPUC Tank: NO_ Y ES NAT'UREOF SERVICE: RO(J'I'INE ._/ EMERUENC)' OBSER,VA,rIONS GOOD CONDITION /FUU.TO CovER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHMELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER-------OTHER EXPLAIN CCN ULNI'S FKANSFUMLD I-0 02 o + 1 '" 1• �' r 7b 91L revk As�',��.(,"f.�r 7F��ri rt ,fy 1. 1. � �.1�! '�f�t'd N J,�•'.+ ,��3 �,.Mi'+h ,,I .1µ/y f, { tl •1� t rtJ ?�i,.�+�•���.�fr,i+l;lt5�:'.yl f1•ag•,i(M� ��tr i s�fF..'` i� rl.`. • l'a; ' • �• �; t ;T y'��,tt 19y,� ""(•# MM alc• t :>f �i ( aF y. , 1,�,} � � ' • � .) � ��j f !�•�d tat• i A�' :n �}��9•�r�r�ilr ti A: �i tt v �l�� �`I' lir y �• 'I � ,r', tri, 4j •� yt�r,,s"� j'�� �"ftti.�.j•;a��' ^' , rv�s;?}t � y } r''4•f 7►y '!. h� i Ifi J !Y r Ay ., r .d}. ..A'.1 lJ N,7 . I 4• t •1'1iA M1l ih.; QWN•�4F Nps L SYS TH A1�pyER r t td } T PUAWWG R.EC L ;tt,dF 4'1�Fi�!• •�4!Y :r ,f l ti i vv.� �! ,j��l•,�(v�s11!iWhl1Yt a,r �a 1 ,, i R•y= t(1� ,,} .! �• �} +, .. t' •. ��! �i�pp r}�� �/ � rL�f ?i1. t ; ,. v Y�. ,lir :'+f y" �� •14' `t J}''�� • Iflf' ati yti'v'Z,S ' •a. 1.M.Ir..t,9; r 1. :r• 1 #; i � f. M't �• t O�j�D r �JT It'ii a �.4 D • , Psi; ? � tlrtt t. gESS SYS�EAZ LpCA '�• +, F . ,' •� TION ,; `� •''Y ,J TSS— ' •�'OOt Of bOYSe� t{,4K:eF 1 1 I r t, .616 ) * .I '- t 4 ' i• 7 1 t {7 41 Mo."9 a, +� „•' ' •,„ lf.';• 1 a..'.' I I 1' - - - ANTITy pUMp q' ,�7� ! I Y t x•<7r + Ey —7 ONS t + 94n,tir�'; .,.M��� OAI,I,ONS r . �yr ���� so j t� h t�M1�'i F M ',`./..•t t +.i, Ili"'T'.r•.� r . ;T , # �• , •ivA1 , -•.1-. -,SEPTIC TAMC•NO 1 ■J'"ra��T•J{.J,(�.�•�ji����4���iu:a�y a ,� - ,4 ,,t� '•' • .�"� (C �i rf TE• ROTTf7•'r+P 7. ! �ERGENCY I•"M1r`f�!r' F I t�tl.+ , ty (7 w. ,* 141 ' �l •1}i • ,. a.dell .i �l•� •1;J r+•.t» +Ft. � S ,A. i �rl!(f •. r IVY GREASE,' "'" ..,., FULL TO COVER 11 al r + !1 ''ACU IN PLACE 'EXCESSIVE SOLWS ' �"""'' ..LEAC,HMMD RUMBA nowCARRYOVER---..� FLOODE/fD7 CK 1 t �' r 'Y,r fi.y f�ik iti + /• --'.'T' OT$ER.. LA JM !I_+ 1 _ 1_MvI�f�d�tp/��.nl� j•�7,V.� r e i1SY+'tFll • 'r ,.{t; \�sli 1 9 fi � ..f�,.11' AJr�u•1 •f l��{!/i1CtKL 1/fi �� + .�. h r ��' , + 1 . �iflt3' N f• .� i`.{w11b 11, njo► v 1"�,�fi!�•'�� �'�x'�'�f t> t I" /� �'Y�� Y�.:ir�Ak`�'II•. .�1� `�1t ! '7 Ji It'�^�1•,• ' l., ( 11+r# ' •d// . f f" 1111111111111111t; it +PAiit!�tt �g1 c .) .fF,t� !f ,. , � � �;. � �' FIVI,hf!1"'Id.:;��^�tl 4t v •+VI t<.. �tr�tSrx+Jt 7r- la�+l"M�r � ! 1 .;. /`//A 1t !!.`.1y c}�i♦ ti} 1 / �/ �� /tel thy} t, • �•. j jY yL�G ' / f l�d�l �J1F y�'►rfvygN'��C�I''�!1 wt'^ly'�'11�R`if�•��a��j�'a�,'• d �`� ,.7' • J' 14l� i�4tiA!! �.1•!k'�IJ .Kt/l l�A II• vrM1`� FORM 4• SYSTEM PlA[I'L\G RECORD Connnonivealth of Massachusetts Massachusetts Poo Svsterrt Purrtp'rt ,Ke vs em ��ne r )stem Locatln V JIM �t r 1 J '7 — antity Pumped: Date of Pumping ( l� l ` Qu., Cesspool: No ,ice 1 eS ❑ Sentir Tont- E] Yes System Pumped by- License #: Contents transferred to- Date o Date Inspector � S s 57_ i 1 �-� 0 t of NoRiH S " OFFICES OF: o �m Town of 120 Main Street APPEALS North Andover, . �-� ;:, NORTH ANDOVER Massach(isetts o 1845 BUILDING %' y CONSERVATION SS4CHUSE4 111\'SIGN OF ((31 7)(3£35-4775 I-HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KARI'N 11.1 '. Nl1I,S( )N, 1111 t1:(;'IOIt April. 4 1988 Robert Nicetta Building Inspector, re= 45 Innis Street Proposed addition A dye test conducted on March 28 1988 and reinspected March 30 1.988 showed no apparent overflow of the Septic System at this site, 'Fhis office wi_11 allow the Hannays to construct the second story addition, as lottg as the resulting number of bedrooms does not exceed three. Sincerel-y 3oa.rd of.. Health -"/Init ar_i an C.C. Bruce Hannay 45 Innis Street North Andover, Mass . J t 5 (tiN15 ST P/:?C)PcxsEp 4049t r/0"Ai v►sir,) SITE- L4hW CKs w6-T- RY )A6- TC-ST /OVP R Socc. ADDra) L-K j(�jj ST, �9�am 5 ufj �J i 12 3-zK 3 ,2 P. N COMMONWEALTH OF MASSACHUSETTS S MASSACHUSETTS SENATE .7 STATE HOUSE, BOSTON 02133 ` COMMITTEES: ENERGY (CHAIRMAN) HUMAN SERVICES AND SENATOR NICHOLAS J. COSTELLO ELDERLY AFFAIRS THIRD ESSEX DISTRICT COMMERCE AND LABOR NATURAL RESOURCES AND ROOM 217, STATE HOUSE AGRICULTURE TEL. 722-1604 SPECIAL COMMISSIONS: SMALL BUSINESS INCUBATORS (CHAIRMAN) n p SHELLFISH INDUSTRY (CHAIRMAN) March 10, 1708 TOURISM (VICE-CHAIRMAN) Conservation Commission North Andover Town Hall North Andover, MA 01845 Dear Members : You have recently received an invitation to a briefing on the state ' s new Solid Waste law. It will take place Thursday, March 24th, at 7 p.m. in the conference section of the Bentley- Library at Northern Essex Community College. The briefing is being organized by my office and the Merrimack Valley Planning Commission and we have asked Mr . Jim Miller, Director of the Division of Solid Waste, to be in attendence. The briefing will present an overview of the solid waste management crisis in Massachusetts, the new regulations which affect communities and the state ' s future plans for recycling, composting and financial assistance. I hope that you will take this opportunity to become familiar with the new provisions of this law and to ask questions of the staff from the Department of Environmental Quality Engineering. I believe that the legislature has developed a comprehensive program of solid waste management ; this briefing should provide us with information vital to continuing our community and regional management programs . If I can be of any assistance to you, please do not hesitate to contact me or my staff at 722-1604. I hope to see you on March 24th. S er y, NICHOLAS J. COSTELLO State Senator NJC/am THIRD ESSEX DISTRICT: METHUEN, HAVERHILL. NORTH ANDOVER, GROVELAND, WEST NEWBURY. MERRIMAC. AMESBURY. NEWBURYPORT AND SALISBURY PLOT FLA:; S 45 Innis Street North Andover, Massachusetts Scale: 1" = 301 Buyer: Bruce Hannay December 19,1980 ,Pefer to Cerh f,tate of T t/e No. 654 , and Land Cou,-f P/an f26 3 8. 197206 p ' 0 SOTS 193 - 200, � LOTS 2W z8 ,k 145 o o � N F LTA , ��a, �--., /00,67 Z0/ I.OTE: This is not a survey and is to be used for mortgage purposes only. N.B.- Do not use offsets for establishing lot lines for the erection of fences, walls hedges, etc. I hereby certify that the building on this property is located as shown on plan and complied with the zoning set back ` requirements of the Town of north Andover when constructed. l :OT APPLICABLE TO FLOOD PLAID ZC IM. CYR EIGIITEERI::G SER.VICES,IIiC. Com/ ✓'C3� �� oZ 5 LAUDE;1 E� MASSACHUSETTS I - . .. � - � { _ e �� SSS .� `*v, t ' f:. .. • a � �T)c JP Fr -^ 1 .. <..,,..�_.. ».-,. t �`�OJ�s� � .. .f. ; ...;.a. ,.mow.., u�.,,s'ay.w++ .•..+raw.es.. � p d�7 � ,e•, +� '/Y�1� ... ;'`, - - .. ,� ` ^..�.:'+,"...,:a.,� ...y,�,yi,.1a.�._�+ •.�.�w`e,s"'"'^�"i+"�.!'i-t.i'.•w.... a o �}✓f/ �• '�Y✓„aywMKi A"pe^P � �t�✓ .wMwe.�,:w"'^Y'yyMr«•.....a+`wi” 5 �-r-., ��AAjj``JJ'�..�.{1�� :,.�w.". �f �. _ .. �' ��E.. '�'^"+ �.+r+w•«. :x��r6/ `�..,,.:w.i..,w.M4.:. ..,'r-w-ya,...�:.«r ,_.• .,may... _ � ��`'� i--�.�"'.:• l # � f f:A„}•wn:.....,+ .:.�... � �l s .-' .. .. ��� _..., t e»» _ ins+ } � .r t �f' A •yi*._i ]///'1c y F -. ., -,».... �� ��� - � ���. ,i r Y,,.:,..o �.r r,�..�..,,q•,....{w+r1..,'..t+i.,w r.. �- cr L r + 3 ._ _. .. ., ,�-' � �c.� � '`alt Z••'.:.° ' j" + � .y ...�- q V a ` - I .. - ++Wi+'+"nid'VN�+y+.y.a'Y:•.Mom rt+•Iv .w.w..Aya,.. ..� Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner System Location V\ 14 Date of Pumping: . — �` �( � Quantity Pumped:�� gallons Cesspool: No� Yes ❑ Septic Tank: No ❑ Yes a System Pumped by: 641`"dm sd4m� License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: I FORM 4- SYSTEM PL11P O O� QO �nJ 0 Commonwealth of Massachusetts Massachusetts System Pumping Record }stem Uwner Svstem Location �cj c,� ual,,Nv\�j ' Vie tv S- Date of Pumping: Quantity Pumped: " /�allons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes c� System Pumped by- � _ License 4: Contents transferred to: C— - Date Inspector WELL DATABASE ACE OF W=, r . WLLDR L �- PEu, ic, DEFi OF WALL: r -T OF a- DRLi..LZD b. DUG _.. T' QFWP3�A.R�iG ROCS VA=.A-YA-I3A=-- DIG�tifAJ�iCAJti�_ Y ELG ON Y N aTrt�.�CQi4TAICYAJYLU: Zv ,zet ADDtRESS: A Gy Or r„_.. 7V � D 7TELL Pa L E7-": WE'D Z LOCATION: L..L PE DA DE?7r OF WELL: TYPE Or WPI.: DFZLr`� b. UG cl liNi�, fol, TYPE OF�i A_IR 3EA RL ROCK: f ` Fi A i A`iA YS:S DATE: F�G'r'_tiL���GA�+ESE: Y N I-�GH RON: Y N 0714—ERCONTA-�,IMV"AI TS: Y N f, 71 �• Ali LLQ ��✓"( .l L j.-ti / { rt } { "..:..,y;'��r'C1b'.>!i ijll tl u�w Vx.CYyRr4 vw (".1!i zl 41 u 'H" ' . • ' �i ' L �qV 'Vv � o�,�• ''',1'S•. \'.,�1�.q,�r t',1,�i 'u''r�rl'.r',)�1::t!"iin',;:r.••�1}',: y•r yy +L+ r.�+. +t,:.",t.• ..._ " ' ,.•,i•y,�N n7C 'V�Ja��� ��,il'S'tYl`��•J�'7�t'�8';'�Sp�`j7,S��!�'JJ'i� Ihri:•�' , �f t r,. �;y'�!),';tt'-YS�Ir t, i( i i 4 1. 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DEP,.has provided 014form for use by local Boards of Health. The s sW 1 PIG be subml4ed to the.1ocal'Board of Health other a HEAL H ' -1 ME T' st t or approving author( i nncNT ' I�' '•11Ii�:..f:!�' i,`1'i�i,iY'�r.tr��,,Y�.:�,r:.,,r• , :A Faclllty Inf9n*jtlon ' Mg*qIIMIM ,j��.YVhedtUWipout System l.ocatlon, :': ' ;f'.,.cor,tpa,ter;•use,;�:• :;:�;•' ::�.', `:,.. �o � - _ �O� onty the tab.'key Address ' to move your'.-: cursor do dot `4 - , use tha return '. :`i .Cit)r own State tr:,t�4 "1'1•tQ ,1�t ;''..;: Zip Code. •Y.':.�Yi ,.Syste "�� :�. ,..y i,�';";,.• �' It , .;`.; :a•,��1� :v!'';fiq i.;.l>.. 'i', �r•:;J'•A,L;:ir.p'•• �\'1+.+•:1:: �`,4�•'y r+�'• Name' �r1: .:J' ,•:vi,i:.If,•�R,;,�i.:�;t',rw: ;lltir' 'Ji: "`" r.', I Address(if different from locatlon) • ` ' '••'-� � ��:CltylTown ,:a :11'ii•:�;:;'••. ^' . . Sta �} aCZlp Code Telephone Number y' i I.�,is 4.1YI.`.'. �'•'7'1' '• ,I.V,1•li^1.. ... .. . .,:•: �:::::,,i,, t;:..• •��P,,uI,11.p1.l1g•�R. .�ord: r,.li�'.,,..1• , :!.!', � il,I ' 1. fv �o(yii�,uy,istjl:lr.'1�0;tci;i.d9iG'JtYSj•1},I;fi`•`�'r9{,'i.•' r• °r`: ` t ..qat0of Pumpin�`f`' 2i Quantl Pu Da tY Pumped: Cations 31.J `.Typo Qf'system;`, ❑ Cesspool(s) 9- eptic Tank ❑ Tight Tank • ;•(�(.Other(describe);•; ' :•Y, ''iii+n.i''�r;J.l',,i'�.'%j:r:„i''.17'ii' 1'V 9..,`.4;x:. 1'.i r} ;;'-.:''; Efiliient•Toa.F(Ite�presgnt?:❑ Yes o If yes, was it cleaned? ❑ Yes ❑ N • _ ,,t � ,.i�l'ti �.II EIla!�'1`{ 1 r' u},I 147'”' �' .1• .. ' d� on,of8yami'.� .- • '' j'J ..,v,J. ht+1 .t:a ,t,.•'�. .�6r.4'i,i,J"••iq y:. .. �_ '�"' i:;:•':�•'''ry• •itl'cY:;�vu`S;'.a:' lair;'!;'ri,Cilt'.Iy\'�':, '; `IRV p •�.,1.. :'tet":,,'a,J1�j Y' ".`:,:`r� i•.�:�;�J+',1. hc� ,. ,:.;5: �'.'.� i \c•iiiwr,A°(.5if.;a•i:'!'' a(ne•1 4r1: .•I,,; �.{,`I +.r1�.� .,.,,',,. ' Vehicle Ucen -'•';,.:,.:•, c;�: ,•,a;, r,. , i �.: 1;�.i1 t .). ;{y";:ly.�, *e Number .Tr";.`��t� rwrjJ� •.J•\t{{;.,i���i,('}t'7;•:4$J4 fy'N`>Jlil 4.11 . .1 'r i, "'11^� /• � " ;r." > •s,;J;• � i.�-.' �.. Y••;14wi�'u +� • 1+ •''flea R' ;°e'.rti?;"; ..:%.) �. T.•r:i. ,itti•11rrFi 1vC• hJ}'r, Y 1�F��" 5��1..r�'i,►'�f. •...,• , •'vr.s,,.rC:�>i+„f•!',�(d•r J+Ja'hi�,rift�. Ih vry If I Iv_ :.:.:•f'.. ri.`o.•vy{yr..i�a,t 1 i }+!�• Jr: f. ti ,.A:C�jr;:;J tG,;t.r,•,,. '�:,; :;:�:��,��.ti,+•;;:;+:7'�,L�oca on:Where•contents,yvere.d(;3pvsed; ' •�•'. '.1- :'J llf h'r' '.r Y 1 ,t,17i�.t��uYt ''Ji.v.j%)'IL L• ly t�<• 1 + t 1� r• . .a�,v• v , !Y:+i�vlrr` 4!� t,,. <y,.� ". i.ti. ifr.• . ;Ji. "4'/•..::at�tl•►;1N„��'f:t'a' rci'✓�i '�1 i'i': ' ''•'>:i;K ,.r�. :i� ! ..Jf%rr.�/'; .. ry (f .(.J".': .r._ 1 ('q' 1"'/: •\";��.•.':1• •l, _ y•li•: ~''j:v't.;•;:,^.'' )-'i. ..i4..:111� 4�.'••I'•j.... 1.� '1;..!. 71,y;,Y.ti�k.s,:'.' , Date tittpJ/wwwimass.gov/ao�!water/epprova)s/t6fo.rmsihtm#Inspect t5fomA.doo1.O6M3 System Pumping Record Page i of i Commonwealth of Massachusetts City/Town of System Pumping Record 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: L4 / on the computer, use only the tab key to move your AddreVscursor-do not IBJ{- i11 M8 use the return City/Town State Zip Code key. 2. System Owner: Name ienun Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record �7 /M� 1. Date of Pumping Date Quantity Pumped: 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 5. Condition of System: 660d 6. System Pumped By: :5rUCZ Name Vehicle License Number Stewart's Septic Service Company 7. Loc � where contents were disposed: St wart's treatment Plant, 20 So. Mill Bradford, Ma 01835 3 1 ture o ul r Date re of Receiving Facility Date _ X3/066 System Pumping Record•Page 1 of 1 No Andover J&S Development dba 1600 Osgood St Stewart's Septic Building 20 Suite 2-36 Andover Septic No.Andover, Ma 01845 58 South Kimball Street Bradford, MA 01835 Date Name &Address Gallons Comments 2-Jul Bake N Joy Willow St 4800 Grease 3-Jul Coltin 316 Rolwey Tavern Lane 1000 Xsolids HG 9-Jul Bake N joy Willow Ave✓ 5000 Grease &**2 inside grease traps 1 Jul Mukherjee 30 Sherwood Dr-.-"' t` i... ;py 1000 Good 8-Jul Hanny 45 Innis street/ 1000 good 19-Jul Butcher Rte 125v�- J6'JpSG oq� 200 grease 19-Jul Chi olte 93 turnpike,,/ 3000 grease 26-Jul Driscoll 110 Forest street✓ 1500 good 26-Jul Hudson 1850 Salem street✓ 1500 good 27-Jul Ferragamo 1112 Tnpk streetv 1500 good 27-Jul Perry 303 Berry street v' 1500 good 30-Jul Barry 62 Stone cleave road 1000 good `�-a5 coo mmec- q4- 1500 00d.