HomeMy WebLinkAboutMiscellaneous - 453 WAVERLY ROAD 4/30/2018 (2)Comm
S Massachusetts
' tea, kr ORTH
ANDOVER;
System e
t� • Record
Form 4
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
®EP has provided this form for use by local Boards of Health.
be submitted to the local Board of Health or other approving a
A. Facility Information
1. System Location:
Address Cali
� �� �� )
Nim/ y,�E' l�a�i<����.y
City/Town State
2. System Owner:
(if different from
Cityrrown
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
U'Qj27
State
Telephone Number
FEB 0 8 2006
Zip Code
Zip Code
%ov
Date 2. Quantity Pumped. Gallons
Cesspool(s) Septic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. ASyem Pumped Sy:
Name „Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler
http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect
Date
must
Q
t5form4.docr 06/03 System Pumping Record - Page i of 1
TOWN OF
SYSTEM
ING RECO RE LVED
AUG 17 2004
TOH�LTH OE T MEONTERR
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
w� S40vt
ac
r
DATE OF PUMPING: QUANTITY PUMPED : /0.00 GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FILL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D V Lowell Waste
Julius Kay. M.D.• Chairman
R. Gcoigc Caron
Uward J. Scanlon
Made By LI nAGc .
BOARD OF HEALTH
NORTHANDOVER
MASSACHUSETTS
01845
C014PLAIIT.P REPORT
TEL. 682-6400
f
Address tl� t
Nature .of Cornpla_i.nt d U /U -�sLS JU d q �^ �G .1-P
al
SrJrl�»gets A/sa i s Aru uej s nr`H
LocationLS3 ✓ Occupant jrp►r��, C�._
Owner or, Agent S Address q:; --� P
ci
Referred -tq
Result of Inves�1gation
Reco=. endations
Action taken
DO NOT WRITE BELOW THIS DINE
Date I ivestigated -
V; 1
s
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 -CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
TEL 682-6483
Ext23
This form must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a copy of th1�e,, sewer connection Permit.
Name , 9- MSS �'"� Phone
Address 453 \-"Jr4ve,-,L- �'`� ��'� ��� t14
Contractor hired for work:
OName Phone �a8
Address 14 l�fe-rti�
Date for scheduled abandonmen
Method of septic tank abandonment (check one).
( ) removal ( ) sandf ill ( ) crush' ( ) other (describe
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
6 �Z
Inspecting Agent _ Dat
Comments _ /I ,60
k -a
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O Co'����� f i
Z& L: %
1056
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. All% 19
Application by the undersigned is hereby made to connect with the town sewer main in UCi t Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. -453 I)G/- Street
or subdivision lot no.
Owner Address
r
14 Ao 04�
Contractor Address
i
pplicant's Signature
O
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
By
Inspected by
Date
See back for rules and regulations
E9
Street
Division of Public Works
(PHONE CALL)
DATE TIME P
PHONED
tF
RETUINED
cl)-A s -'q y
PHONE. Q, CALL
AREA CODE NUMBER EXTONSIO
N PLE4E CALL
MESSA E
WECCALL
AdAIN
OT4
CAMETO
SEE. YOU
FWANTSTO
SEE YOU
'SIGNED TOPS FORM 4003
�-•r
a
--I
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
North Andover, Massachusetts 01845
(508)688-9533
December 17, 1995
Pat Leyman
43-25 Douglaston Parkway
Apt 5C
Douglaston, N.Y. 11363
Dear Ms. Leyman:
'tt`eo s�e'�'OG
Pursuant to our discussion some weeks ago concerning the
property at X45 --Waverly Roadxin North Andover, Massachusetts, the
local Department of Public Works has informed me that municipal
sewer is available at that address. According to Board of Health
regulations adopted on March 17, 1994, 114.2 All establishments
outside the North Andover watershed that are currently able to
connect with the municipal sewer have a maximum of two (2) years
from March 17, 1994 to tie-in." This particular section refers to
your property on Waverly Road. Of course, at this point in the
year all sewer connections have been completed for the year, so it
would be expected that the owner of 453 Waverly Road would connect
to town sewer as soon as possible in the spring of 1996.
If you have any questions about this process, please call the
Board of Health at the number below or the Department of Public
Works at 508-685-0950.
Sincerely,
�_v
_,�, &,-,) Sandra Starr, R.S.
Health Administrator
CC: B. Hmurciak
CFil�
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Julie Par ino . D. Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell