HomeMy WebLinkAboutMiscellaneous - 465 CHESTNUT STREET 4/30/2018 >>> 465 CHESTNUT STREET
J.� 210/098.C-0030-0000.00000.0
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Commonwealth of Massachusetts RBD
City/Town of
APR 2 2 2013
System Pumping Record
TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPARTMENT
M V
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.
A. Facility Information
1. System Location: Left/Right front of hous ,Pding,
Rig ea ofhouse, eft/right side of house, LeftRight side of building, Left/Right front of buLeft/Right—re—a—rd—fruilding, Under deck
Address
l.�'/ r & !S—
City/Town
City/Town (� state `C Zip Code
2. System Owner.
Name CEJ
Address(if different from location)
City/Town State/'1����, ip Cede
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) El ptic Tank ❑ Ti ht Tank
ther(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No.
5. Condition of,System-
OR
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location re contents were disposed:
Lowell Waste Water
Signitufe Haule Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts RECEIVED
City/Town of
quo
System Pumping Record APR � 2012
Form 4
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. Oth e
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.
A. Facility Information
1. System Location: Left/Right front of house Right r of ho , Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
Cityfrown (� State Zip Code
2. System Owner.
Name "J bcv
Address(if different from location)
Cityrrown State ` Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) ElSeptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 0 If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System: A, L
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Lo ere contents were disposed:
G. SkHallee,
Lowell Waste Water
Sign Date
t5form4.doc•06/03
System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of RECE7F-D
System Pumping Record
Form 4 APR
M
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other ME M2MMthff
information must be substantially the same as that provided here. Be ore 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.
A. Facility Information
1. System Location:Left/Right front of house,/Righ f hou , Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
City/Town �( State Zip Code
2. System Owner.
v�
Name
Address(if different from location)
City/Town State��� 7� Zip C e
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ esspool(s) ❑ Septic Tank Tight Tank
ther(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location whm contents were disposed:
48ign
AHaule
Lowell Waste Water
Date
t5form4.doc•06/03
System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts RECEIVED
City/Town of €i 2011
}
System Pumping Record ?
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.
A. Facility Information
1. System Location: Left front of house, right front of house, left side of house, right side of house, Left
rear of house, right rear of house, left side of building, right rear of building, under deck.
t-) 5 C A066Q"
Cityrrown State Zip Code
2. System Owner*
&C 0
Name
Address(if different from location)
City/Town State Zip Code
Q�3 - 7� ay
Telephone Number
c
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank
❑ Other(describe): - " �C"
4. Effluent Tee Filter present? ❑ Yes F�,,J/No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Locat'LQn where contents were disposed:
L. .D Lowell Waste Water
Signature of Hau r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
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RECEIVED
DOVER MASSA
CRUSE
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JAN 0 S .2009
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/addresssTktu-I J
Title of File
Page of
Date File Open:
Gate file closed:
Doc Document/Action Title Date of
action Refer to other Purpose of I�ocuntent/Action and notes
Document/ document/
Num. Action T
De artrnent
Board of Appeals — Board of Health — Planning Board _ Conservation Comm'
Ission -
Building Departr,ent
4
Noah ANb6ver Q-a
l�d Mo,n St. -91�RVS SEPTIC TM S.EtVICE
47 R
Ne/4h A r lranve� Ajj,R� STREEP
BWFORD, MA 01835
0-moi Lie- t5/-O&N
978-372-7471
momm OF
Motlii,Y REPORT FOR TOWN OF
DATE _
ADDS
GALLONS Ems
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