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Home My WebLink AboutMiscellaneous - 490 WINTER STREET 4/30/2018 (5)North Andover Board of Assessors Public Access 1 Of ,TORT .,M 9SSACNUS�t Click Sea] To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors Property Record Card PnrcPI TTl •7.10/1 fiA A-0077-00000 1:V•7MA CA—m—it" • N—+16 Andnvnr Location: 496 WINTER STREET Owner Name: ZENGILOWSKI, RICHARD & PAMELA Owner Address: 496 WINTER STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 1.02 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1452 sqft ASSESSMENTS all Value: lding Value: id Value: rket Land Value: ipter Land Value: CURRENT YEAR 423,600 214,800 208,800 208,800 PREVIOUS YEAR 448,400 217,400 231,000 http://csc-ma.us/PROPAPP/display.do?linkld=1180173&town=NandoverPubAcc 8/14/2008 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. t5form4.doc• 03/06 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record NORTH ANDOVER AUG 011-015 Form 4 TOWN OF NORTH ANDOVER T n P RTt-9EN f DEP has provided this form for use by local Boards of Health. Other forms may be um,�ntlFhf, 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 1. System Location: Addr� CitY !Town State Zip Code 2. System Owr)er.to wq� ` Name-- — — — - .� Address (if different from location) Ci Yr own State Zip Code --57 .3... tt� Telephone Number - - - B. Pumping Record 1. Date of Pumping ------_____._... _....._._— 2. Quantity Pumped: --- Date Gallons 3. Type of system: ❑ Cesspool(s) �eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): _._ ..._. _ _ _ ... --- _..... _. .-.._....._ ......._ :•..-__ -- -.. 4. Effluent Tee Filter present? ❑ Yes Io If yes, was it cleaned? ❑ Yes 5. Condition of System: r 6. System Pumped By: Wind River EnviroMmutal - - - 163 Western -Ave. Veh -- - - - ------ - - -- Name----- — icle`License Number --.--..-.G1ou=ur,J" ai93o_....__ _ Company 7. Location where contents were disposed: C, LS Signature of Hauler Date — —__ _---- ► Ll� — -_ ...._._..—.. Signature of Receiving Facility' , Date System Pumping Record • Page 1 of 1 Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, August 14, 2008 11:34 AM To:'zengilowskip@northandover. k12.ma. us' Subject: FW: 496 Winter Street - Septic Information Attached is a copy of your Health Dept. file. Based on the file information, it appears that you have a 1,000 gallon septic tank. Please call the office if you have any further questions. toes/ R1004441 P4#11004 0ee0e401CA1.0 Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 $978.688.9540 - Phone A- 978.688.8476 - Fax http:ff w %w.townofnorthandover.com healthdept@townofnorthandover.com From: noreply@yourcopier.com [mailto:noreply@yourcopier.com] Sent: Thursday, August 14, 2008 12:17 PM To: DelleChiaie, Pamela Subject: 496 Winter Street - Septic Information 8/14/2008 UA I't TOWN OF NORTH ANDOVE�, SYSTEM PUMPING RECOKI) SYSTEM 0WNRR ADDUSS 0 TO I tM LOCATION �m�iic Wank: Nu y e s NA rUKU OF SeRvICE: Rou'rINE, RECEIVED ECOVED QMAVA'nom: GOOD CONDITION 0 JUN 0 3 2005 KEAYY OUAU uLL'm covbp, — BAYnBS IN PLAUL OF a T ROM TOWN OF NORTH ANDOVER LT p Tm T LBACKPIeLD KLIN DEPARTMENT TOWN D AR BACK,...LE "cusivo SOLIDS FLOODED 40LrD CAPXYOYER,—.-. OrKER EXPLAIN VUMMENTS. t.:vN rein's rmNsnmbo rL, w DATE D SYSTEM OWNER & ADDRESS $HANDOVER SysTtm PuwlN(3 RECORD DATE OPPUMPIN�}�, QUANT TY•PUMPED CESSPOOi, NO, YgS \ / SEPTIC TANK NOYES_ NATURE OF SERVICE;;,RQ�VI'�NE� B�KOENCY k.�r, •. ,• at '. X1)4 } .,;.1 � /t I � •�•5 �� ,:) ?,�:• w, - . ` r 1 );, . �. ::;i..:..�d1�rt��L9dltit.,:'��> -------------- $HANDOVER SysTtm PuwlN(3 RECORD DATE OPPUMPIN�}�, QUANT TY•PUMPED CESSPOOi, NO, YgS \ / SEPTIC TANK NOYES_ NATURE OF SERVICE;;,RQ�VI'�NE� B�KOENCY k.�r, •. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: _ Owner's Address: Date of Inspection: ��--a5"- Name of Inspector: (please print) /&f/ 90 S� Company Name: Mailing Address: 3 / rte, Telephone Number:" CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes. Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: ,� Date: The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and,6e approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 4$ -Rage 2 of I 1 OFFICIAL INSPECTION FORM-- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 41 i Owner: Date of Inspection: Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: }� I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. 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. Answer yes, no or not determined (Y,N ND) in.the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old' or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced - obstruction is removed distribution box isAeveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ND explain: broken pipe(s) are replaced obstruction is removed r+ r Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: V!2 (a Owner: '' 14 # Ate Date of Inspection: 7,�1� G �i C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, 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 Jp/pi/iel�, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or .tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the. SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are Triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Owner: ?'Q AIA ry Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No �ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ZI-15ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Matic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or �esspool iquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow .-,Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ 6, -'Any portion of the SAS, cesspool or privy is below high ground water elevation. _ ;' y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface . wester supply. _ c --Any portion of a cesspool or privy is within a Zone 1 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 from a private water . supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] --90/yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems:, . To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• You must indicate either "yes" or "no" to each of the following: . (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water 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 Protection Area — IWPA) or a napped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 k' It . OPage 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE. SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: "T �l/ '41z'C1z -5-) Owner: Date of Inspection: Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? ✓Have large volumes of water been introduced to the system recently or as part of this inspection ? t� Were as built plans of the system obtained and examined? (If they were not available note as N/A) L'/ _ Was the facility or dwelling inspected for signs of sewage back up _ Was the site inspected for signs of break out ? �_ Were all system components, excluding the SAS, located on site ? _�_ Were the septic tank manholes uncovered. opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? L'he_ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. ( Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 1.0 CMR 15.302(3)(b)] j, N", Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection:' FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): E'' Number of bedrooms (actual): T DESIGN flow based on 310 CMR` 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: _a Does residence. have a garbage grinder (yes or no): O Is laundry on a separate sewage system (yes or no): Wjif yes separate inspection required) Laundry system inspected (yesor no): _ Seasonal use: (yes or no): _% 0 . Water meter readings, if available (last 2 years usage (gpd)): Sump Pump (yes or no):� j Last date of occupancy: _Lzn_1y J r. 4- COMMERCIALANDUSTRIAL Type of establishment: YA. Design flow (based on 310 CMR 15.203): _ gpd Basis of design flow (seats/persons/sqft,etc.): 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/use: OTHER (describe): GENERAL INFORMATION Pumping Records t, Source of information: A N 4 0 0"5— /7 r�2 7-0 u Was system pumped as part of the inspection (yes or no): V� 3 If yes, volume pumped:�gallons -- How was quantipumped determined? Reason for pumping: 0 / )(.3'y G` � S q TYPE SYSTEM vgeptic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous -inspection records, if any) Innovative/Alternative technology. Attach a copy of the current, operation and maintenance contract (to be obtained from system owner) _ Tight tank Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): /140 6 Page 7 of 1 I OFFICIAL INSPECTION FORM.— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address•-/G%�%/il�/Z-t'/ Owner L J / Date of Inspection: BUILDING SEWER (locate on site plan) - Depth below grade: Materials of construction: mast iron 40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: tl!(locate on site plan) ri Depth below grade; 'concrete Material of construction: ✓_metal _fiberglass polyethylene —other(explain) If tank is metal list age: _ Is age confirmed by. a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee of baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Al i T Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I�6 -,A 0C) 1,9 Only 1) / 7-16M-/ GREASE TRAPzJ '' ocate on sitelan P ) Depth below grade: Material of construction: _concrete - metal _fiberglass Polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels .as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: zjell1y1C2 _5,'/ Owner: Date of Inspection: "lf --G b TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level:. Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: Yelif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t 7'7(/ -A -i PUMP CHAMBER: locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " Wage 9 of 11 OFFICIAL INSPECTION FORM,- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:-, (�"�J�J� R 5 J! Owner: A/ A54 Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): Ya- ocate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: aching trenches, number, length: 1 leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CESSPOOLS: H, ' (cesspool must be pumped as part of inspect ion)(]ocate 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 (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: ' ' (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 vegetation, etc.): 9 Page 10 of l 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 2NFORMATION (continued) Property Address: �G �iU%1�/��L��. .51 Owner: 1 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage.disposal system including ties to at least two.permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.. . BBSe a v� Tim j./to 2.P' 10 9 10 3 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:��/.�i%��/j Sl Owner: Date of Inspection: SITE EXAM. Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: fined from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked.with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: u Gt �,/e- e�2 S S ,moo l v: llrC DM 7n-ee / oc C'P /71/f—dAcu ra ,kl& `Y, S�lC/•i5 C�l 'Z�\ v I- ) J x J w z t� �o G7 n CC C� CN q\ QN v I- ) J x J w z t� �o (- ?�, 4-� ci c3, e '7 DI&Oealf- 19=> Xl- 0-T 3 loth GRI 10, LA oe V% �ILZAID - C, c; cry--.- 0 � i 1 N i - rd • t � c> o ai n � � ..c,.,sra �c•� o cae!� •� ¢� m m +gym fit./ I t�IT�i� ST •r � 1��5 � • 4 f W ioa®ph i. bar•baoallo_ rr_=_ 1 %wiaQ+-IIAIZM % i f%16%OhM w.. r .,mA .... .Y—�_ TOWN OF NOR' TIME -OFF RE' Name: Department: Date(s) of Request: Please check: Vacation Other (Explain) : Department Head Approval White - Department Copy '`. Ye]Aow - E I TO: FROM: NORTH ANDOVER, MASS O C 7— C 19 7-5- BOARD sBOARD OF HEALTH DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at Z-(1 %` tE R S 7`` North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 W!1 El I Ahs b,6,,Tm �•-7 0 a- a 1 3 1 �rOZ bG�Z.Es y 10g�-e- f �' I�,IL f na cr >r A ,° + (90 ' 1000 ear f14 ��. -35, , e � f too, 0 tPr r� f i N/ coo 6 a o e> 40 i m, �� ca me o ramomAP.oCaom� ST. h 1 uuoctuvzmrl+cl 44 d1 9 i V Y. P IE I � bg'oo► 13�1no commonwealth of �ta�sachuutts NORTH ANDOVER, Massachusetts PAM ZENGLIOWSKI F_ RECEI Date of Pumping: 8/18/08 Cesspool: No 0 SEP 15 2108 HEALTH DEPARTMENT 496 WINTER STREET Quantity Pumped: 1250 gallons Yes . 0 Septic Tank: No 0 Yes 0 ItAGGS SEPTIC SERVICE, INC. Sy stem Pumped br: d.b.a. E . A . COMEAU SEPTIC License w: Contents transferred to:VATR SOLUTRfdNS GROUP, TAUNTON Date 8/18/08 _-`Inspector RAGGS SEPTIC SERVICE, INC. a� Nov 'I c 2010 TOWN OF NORTH ANDOVER I HEALTH DEPARTMENT Vib•� ' Ur • • �. • • w•r 46,1V swag Commonwealth of 1ltatrmchttsetts N, �t, Yom , Massachusetts -Z-2nJ /,' 0 w Sk I Date of Pumping: _ 10 // !/ U Cesspool: No b yes*. ❑ .4 � � - �Z) /\-,-) �-& P - Quantity Pumped: /,:�- Se gallons Septic Taal:: No ❑ Yes ❑J RAGGS SEPTIC SERVICE, INC. S3 -stem Pumped by: d . b. a . z. A. COMEAU SEPTIC License R: Contents transferred 'to: _ CE, RAYMM Date /() 1-4 110 Inspector RAGGS SEPTIC SERVICE, INC