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Home My WebLink AboutMiscellaneous - 50 FARNUM STREET 4/30/2018 50 FARNUM STREET J - 210/107.R-M7-0000.0 - Commonwealth of Massachusetts City/Town of System Pumping.Record LC M4 Form 4 DEP has provided this form for use,by local Boards of Health. Other forms niay 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 house, Le IS/ t rear of ho Left/right side of house, Left/ Right side of building, Left/Right front of buildingRight rear of building, Under deck Address .moo City/Town State Zip Code 2. System Owner. Name' Address(if different from location) Cihr/Townstate: ' �r�Code --7.�C`— `Z f Telephone Number B. Pumping Record 1. Date of Pum in P 9Dam 2. Quantity Pumped: Gallons 3. Type of system: ❑ cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yep if yes,was it cleaned? ❑ Yes ❑ No " 5. Condition of 6. System Pumped By. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7, Lo contents were disposed: • G01S, Lowell Waste Water Sigau Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts ^ RECEIVED G City/Town of w° System Pumping Record JUL 012013 Form 4 TOWN Of NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of HealOther 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 house, Left ight rear of hous. Left/right side of house, Left/ Right side of building, Left/Right front of building, a of building, Under deck Address \� City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Telephone Number UU B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? YesEl No 5. Conditio of Systeme _ t 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locat' where contents were disposed: G... S. Lowell Waste Water SignAtufe Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts W City/Town of Z. us:inag VED System Pumping Record g 2009 41M SVy`aw Form 4 SEP DOVER DEP has provided this form for use by local Boards of Health. h5% t theinformation must be substantially the same as that provided hethis 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 sid fight side of house, Left front of house, Right front of house, Left rear of ho , Ight rear of h` Address City/Town State Zip Code 2. System Owner: Name Address(if different from location) Cityrrown State ip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Galldrhs 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes P--KO If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: t`n ' ' p f `R9 \ (^ 4� ak� 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Locatio a contents were disposed: aDLowell Waste Water S' n Date L t5form4.doc•06/03 System Pumping Record•Page 1 of 1 ` t ' commonwealth of Massachusetts .City, own ,of NORTH ANDOVER MASSACHUSETTS A 14stem Pumping Record Form 4 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 OCT 1 2 2006 Important: When filling out 1. System Location: -" forms on the computer, use only the tab key Address • to move your -- --- cursor•do not Cit /Town – — use the return y State – ` --' Zip Code key. 2. System Owner: Name - 5V P�"O' hoq St _..____.__._--- ..._.._. - — --- -- -- - Addres,s(if diffefent from location) _...._ City/-Town --- --- State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping - Dat ZZ Quantity Pumped: Gallons 3, Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Qther(describe): ------_ 4, Effluent Tee Filter present? ❑ Yes 0 If yes, was it cleaned? ❑ Yes ❑ No r 5. Condition of System: r - 6, AsYem Pumped By: — Vehicle License Number • t %� �' c5 a Company - 7. Location where contents were disposed: /yy��, Si ature of Hsu t//' --- Date _. ._._... http://www.mas§�govi/dep/water/ AW t5form4.doc-06/03 System Pumping Record•Page 1 of , TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: _6-j!y- / SYSTEM OWNER &ADDRESS SYSTEM LOCATION LTC?— (`example: left front of house) 5-0 Fccw-UAB`,I ' DATE OF PUMPING:-—1q 70f QUANTITY PUMPED_ y GALLONS CESSPOOL: NO YES SEP IC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: 4L COMMENTS: '' CONTENTS TRANSFERRED TO: L- S Farr) George Lot 15, Farnham St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION S Io HEALTH DEPARTMENT - NORTH ANDOVER, MASS. �/ iY1t,�W-I I hereby make application for a permit for a sewage disposal installation at Lot 15, Farnham St. . I will install this system in ac- cordance with all the laws of the' Cor mmonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 290. I will install a con- crete septic tank of 1000 gpl, in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 180 lineal (&quave) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation W�ll be less than 100 feet from any private water supply, 25 feet from any stream, 20 fed from any dwelling or 10 feet from any property line. I further agree not to cover any Option of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE/ S' nature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE C� Signature of petting Offic r Percolation Test 4 min. Soil: Gravel-clay Garbage Grinder No 4 kJ BOARD OF HEALTH / TOWN OF NORTH ANDOVER, MASS. !w d o � i ` 1Q'MIA . a L J A 0 iC- ool 1. NAME rg y-f'" �S cue non,��. DATE�/�. 2. ADDRESS , - -��„ LOT NO. TEL. ,�'1� 3. NO. OF BEDROOMS DEN YES ' NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9• NOS" EWERAGE SYSTEM ---- 10. SHOW LOCATION OF BReffi&r S9P&* M3, DIS, L9P"-4#VMPT ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE D., NAME OF APPLICANT_ LOCATION , Addr ss o o no. BUILDING: Dwelling Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND T4J Zh SUBSOIL: Clay Gravel_; Sand PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 gallon capacity. LEACH FIELD 180 _—lineal feet of drain pipe. JJV William *alrth coll , gineer Board of � J �Q ` j \. re w _ -k i z 7-�� ( ( �Ghd ��5 r�Gi✓avj I � SOti''�C1j t wool . J ' 1 Sj 4- 5r" t' yep''-Gy�r E �o � �-�A� address , � n,,� ST Title of Fide page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes. action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planniing Board - Consery ation Commission - Building Departrner