HomeMy WebLinkAboutMiscellaneous - 586 SALEM STREET 4/30/2018 (3) 586 SALEM STREET -
� 210/038.0-0100-0000.0
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586 SALEM STREET
210/038.0-0100-0000.0
9451
Date...
NORTq
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
CHUS
This certifies that ....... ...... .............................................................
has permission to perform . :n 5ni�v......................................
/Y
A-
wiring in the building of.............A/f..............................................................
at...3....... ...........57"../e.............5 ......... North Andover,Mass.
Fee... Lic.No.� .............. ... ...........L.. .............. ........ ...
ELECTRICAL INSPECTOR
Check #
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
x BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev, 1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC);527 CMR 12.00
(PLEASE PRI EV B%K OR TYPE ALL INFOR ATJO19 Date:
City or Town of: NORTH ANDOVER
To.the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) t— _6 �-
Owner or Tenant C N ��c ,_
Telephone No.
Owner's Address S'At__ IC
Is this permit in conjunction with a building permit? yes ❑ No
Purpose of Building Check Appropriate Box)
Utility Authorization No.
Existing Service 4 l/ Amps ,jd/2 yU Volts
Overhead Undgrd❑ No.of Meters /
New Service Amps. / Volts Overhead
❑ Undgrd ❑ No.of Meters
Number of Feeders and.Ampacity
Location and Nature of Proposed Electrical Work.
Com lesion o the ollowin table may be waived by the Inspector of Wires.
No,of Recessed Luminaires No.of CeiL.-Susp•(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Above in-
S o.o
Swimming Pool ❑ mergency g
d. d. Batte Units
- No,of Receptacle Outlets No.of Oil Burners
EIRE ALAILMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
No.of es Rang Total Initiatin Devices .
No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers eat PSP Number Tons KW No.of Self ontained
Totals: - Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
i Connection ❑ Other
No.of Dryers Heating Appliances kW Security Systems:*
o.of Water No.ofo. No,of Devices or Equivalent
Heaters KW Signs Ballasts . Data Wiring:
No.of Devices or E uivaIent
No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring:
OTHER: No,of Devices or E uivalent
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
(When required by municipal policy.)
Work to Start l -�/(J Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such co=BO;�;
force,andhas exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ OTHER
❑ .(Specify:)
I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete.
- -,FIRM NAME: � `� /Y`�'
Licensee: LIC.NO::
Signature l" LIC.NO.:
(If applica e, a er"exempt"in icense number line)
Address: Bus.Tel.No.:
*Per M.G. c. 147,s.'57-61,security work requires Department of Public SafetyAIL TeL No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does noa e,the�liability insurancLic.e coverage normally
required by law. By my signature below,I hereby waive this req uir
emen
t. I a
Owner/Agent m the(check one) ❑owner ❑owners agent
Signature Telephone No. PERMIT FEE:S
The Commonweizith of Massachusetts
Department o f industrial_accidents
Office of fnvesrzgadons
600 Washington Street
Bostorz, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
AopIicant Information
Please Print Lealibly
Name (Business/Ctgpmization/Indivi dual):
Address:
City/State/Zip: Phone#:
7A-reu an employer?Check the appropriate boa:
am a emplo er with 4, Type of project(re airedY I b q❑ am a )neralcontractor and I
mployees(full and/or part-time).* have hired the sub-contractors 6 ❑Nem constructionam a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling
ship and have no employees These subcontractors have
working for me in any capacity. workers' comp.insurance. 8' ❑Demolition
<) [No workers' comp. insrrance 5. ❑ We are a corporation and its 9' ❑Building addition
3.❑ required.] officers have exercised their 10-ElElectrical repairs or additions
_I am a homeowner doing all work right of ex
emption per MGL 1 1.7 Plumbing repairs or additions
myself [No workers' comp. c. 152,§I(4),and we have no
inIsurance required.] t employees. [No workers' 12.❑Roof repairs
comp.insurance required_] 13•0 Other
.Amy applicant that ch=ks bo::-1 mus!a-Iso iMcu:,
i ne aecti^=belen io.. r= fir Werke s'cos^� r
homeowners who submit this affidavit indicatingthe;,are ao:•, n r-•==-=Y�b-� moa.
'`Contractors that abed:this box must attached an additional sheet showing ffi a �hire outside con re o s dust submit a new affidavit indicating such.
name of the sub-contractors and their workers'comp.policy,information.
I am an employer that is providing workers'compensador,insury eance or m
information. f mployem Below is the policy and job site
Insurance Company Name:
Policy#or Self-ins.Lic.#
Expiration Date:
Job Site Address:
Attach a copy of the workers' C
compensation policy declaration aawe(showingty/State/Zip:
P she policy number and expiration date).
one up to$1,500.00 and/or Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
of up to$250.00 a day agdeone-year imprisonment,as well as civil penalties in the formainst the violator. Be advised that a copy of this of a STOP WORK ORDER and a fine
Investigations of the DIA for insurance coverage verification statement maybe forwarded to the Office a
I do hereby cerdfj,under the pains and penalties of perjury thizt the information provided abO1e is true and correct
Sign are:
Phone#:
Official use only. Do not write in this area, to be completed bj,citj,or town ofj ficial
City or Town:
Permitucense#
Issuing Authority(circle onej:
1. Board of Health 2.Building
Department 3.
6. Other City/Town Clerk 4.Electrical inspector c.
p
lunttIns ec
Inspector
Contact Person:
Phone #:
j
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pude- ch4d w f I 6c ��� To
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-
WOO GAS. GEST. r) l4 to Gov En.
BOX
TL-pr
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DiSPOSA L `�/ST I� fP-flr-tL� �x�St k rr
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A4zso r- A tom +
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3011
Q�.�'r tpu 8�D PLAN
1. <-uT ALL SOIL W I-EI7 AZEA r u S ALL Dl2EGTiorj5
2t�F1LL W)TH COARS2AVt✓L -Fo CA" gi~L.c)W '
STR-rzr=T 41ZAPF ,
2 WATER. TAGLE IMPOIJND&I> ST1NDtrJ�� kT' CR!lt�g
3. tJo R.0 TEST buE Tv 6P-OuOD WArar2 1L)Ml?FF-2EIaGE
Memo: fo Board of Health
Regarding,:' Complaint at 586 Salem St.
Froh: Len Phillips
i
1 : Home owner, Dr. Robert Nicolosi, orally complained about his
own Septic System on Oct. 18, 1977•
2: Investigation determined that property was built by Chester
Sullivan. --
3: Site inspection at owners request was made by Joe Cushing and 1
and Len Phillips on Oct. 20, 1977.
Results: A; System is obviously failing
B: System was recently pumped out, but is already to
the point of failure again.
C: Damage to the interior of the house at the basement
level has occuredr due to the overflowing Septic
System.
D: Effluent is punching out along the property line.
E: Water from the distribution Box And the field is
said to run back into the tank after pumping.
Recommendations:
A: Owner hire an installer to open distribution box
and dig a pit to determine ground water. Distribution
box may indicate source of trouble. ,
B: If need be,test holes could.be dug in various
places around the absorption bed
Co. Final recomendations will be made as soon as the
problem is identified.
,1
{
! PERChuinnan BOARD OF HEALTH
R.Juliu?'Kay, M n.,
Y}}illi
�((,)ig(' Ca"'n NORTH ANDOVER >} OFT
Fd-ard J. Scanlon o ,. R,lorr
MASSACHUSETTS
01845 i o:•��r,,R�RArfo:
— APRIL HT1 ��F
k 4- 185$
� 9 •'fig.i
kss SACHU`�'F'{,'
�y*rrr+rte
TEL. 682-6400
Feb b, 1972
Mir. Charles Foster,Building Inspector
Totan Hall
North Andover, Mass.
Dear Mr. Foster:
This Board hereby voids Septic Tank
D erm' t 7'303, dated January 23, 19?3, issued to Chester
Sullivan for Lot 2, Salem St. ' This action is taken
Tn..nding a m:�re thorough study of the percolation tests
by our sanitary engineer.
Very truly yours,
qChai _J r
rman
Kay, M.D.
/r
1
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Commonwealth.of Massachusetts
City/Town of
System Pumping Record MAY o 2007
Forth 4 TO\N- � H ANDOVER
HEA�T�DEPARTMENT
DEP has provided this form for use by local Boards of Health. The System Pumping Record must
be submitted to the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out 1. System cation:
forms on the
computer,use ev� -
only the tab key Address
to move your
cursor-do not M
use the /
Gityfrown ate
return Zip Code
key.
2. System Owner:
Y ,
Name
Address(if different from location)
CityFrown State
Zip Code'
Telephone Number
B. Pumping Record
1 Date of Pum.ptng L
� 7 2. Quantity'Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank.
Other❑ (describe)
4. Effluent Tee Filter present? ❑ Yes 19-10 If yes, was it cleaned? ❑ Yes`❑ No
' S. Condition
6: System P m p e d BZ,".
Name
Vehicle License Number
Company
7. Location w e contents were di ed:.
o
signature of au r
Date
http://www.mass.gov/dep/`wateriappto. als/t5forms htrnAnspect
t5forrn4.doc•06103 system Pumping Record Page.1 of 1
Commonwealth of Massachusetts :WHIEAOLTH
�I��D
19City/Town of
System Pumping RecordF 2 5 2006
Form 4
Le
EPARTfv10EOTER
DEP has provided this form for use by local Boards of Health. Tumping Record must
be submitted to the local Board of Health or other approving authority. .
A. Facility Information
.Important:
When filling out 1. Syst m Location:
forms on the
computer,use
only the tab key Address e^
to move your
cursor-do not City/Town
use the retum Stto Zip Code
key.
2. System Owner.
i
Name
Address(if different from location)
City./Town St ,p de
Telephone Number
B. Pu
mRecord
ping .
1. .Date.of Pumping date 2. Quantity`Pumped:
. Gallons
.3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight,Tank
❑ Other(describe)
-
.4. Effluent Tee Filter present? ❑ Yes No If es, was it cleaned? Ye
Y ❑ s ❑ No
5. Condition of System: A "
6. Syste PT�d C y..
Name C�1� Vehicle License Number
Company -- .
.7. Loca' n where contentere disposed:,
ZSigtuf auler Date
http://www.mass.gov/dep/`Water/approvalg/t5forms.htm#inspect
t5form4.doc•06103 System Pumping Record•Page 1 of 1
TOWN OF AAjo qf-c
SYSTEM PUMPING RECORD
, OGT " 3 2003
d
DATE: -0,2) --J
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
c (example:left front of house)
ko�ks-e-
DATE OF PUMPING: ` d QUANTITY PUMPED : GALLONS
CESSPOOL: NO V YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACIOULD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D V/ Lowell Waste
s
I
3
FOIUI U
' # TOWN OF NORTH ANDOVER
k
' i LOT RELEASE FORM
s
`7 SUBDIVISION
ASSESSORS MAP l O�
SUBDIVISION LOT(S)
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
I' " STREET-,
i
APPLICANT �L C,�' T" N �, L D PHONE �j�F� - q
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PLANNING BO RD
DATE APPROVED ] - ell
TOWN PLANNER DATE REJECTED
h
CONSERVATION COMMISSION
,j
DATE APPROVEDG
CONSERVATION ADMIN. DATE REJECTED --�
a /BOARD OF EALTH
DATE APPROVED
fiLALT 1 A T RIAN �o�sr�2v�a� of DATE REJECTED
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT
SEWER/WATER CONNECTIONS
FIRE DEPT.
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the. Planning and health Boards,
the Conservation Commission prior to the issuance of any building; permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example: left front of house)
PN cc)
DATE OF PUMPING: QUANTITY PUMPED_,G�"GALLONS
CESSPOOL: NO '� YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
i
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
h.?D CSF B rO
CONTENTS TRANSFERRED TO: n C'' �' �'
.���- .�. `,+4.� -�'' .• �, .:_C� - _ _ Vii. _`_- ,: • -
ALW
Rit
rArl
IWZ
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..r,, ♦t't; r n't to 1 � Ac _
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t�t Al ! •� J'y't
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Sa i i •
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IN
C�T
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i -
SII
TOWN OF
SYSTEM PUMPING RECORD
RECEIVED
DATE: - 5"b 5
APR 13 2005
NORTH ANDOVER
SYSTEM OWNE & ADDRESS SYSTEM LO A °
(example:left front of house)
pp
DATE OF PUMPING: "'� 5=0� QUANTITY
PUMPED : G LONS
CESSPOOL: NO___z YES SEPTIC 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: Bateson Enterprises, Inc.
COMMENTS:
I
I
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
Fli � ,� 4•. f. ✓� � 1 1
t.
i ) )
7 � n
ftfJ,
':i. ..+lwf- .. 'ry+llta s r_�i- `�- < .a- .s .:�c�; .a :1�•
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ANDOVZR
t'tt■'i't'■'t ' ■ '�JjY ■'i /'■ t ■ t
: HOUSEHOLD
■,■i t ■�� ,'t'■'■'t ■� 'i' H A
NDOVER
■'
i t ■ t ■ . , t . t
HAZARDOUS
BRING YOUR LEFTOVER:
Pressurized cans
Waste oil WASTE
• Pesticides
Paint thinners & solvents
Oil based paints (no latex)
Oven cleaner. Drano & toilet cleanser COLLECTION
Car waxes & battery fluids
Chemistry sets
Wood pgeservatives. stains & varnishes
Photographic and pool chemicals
Outdated pharmaceuticals
Fertilizers & herbicides
Rodent. mosquito & weed killers
NP-pest strips. flea collars & powders MZRRIMACK
NO BATTERIES will be collected. COLLZGE
ALLOWANCE: 5 gallons or 5 pounds
Proof of residency required.
SATURDAY APRIL 30
10!. !
! !
00-200
For more information call :
Andover: 470-3800 Ext. 255
North Andover: 686-3812
1
i�`�sl�. } _ l_., '�l. ''.�'•' _ !. �'� _. ._ ._ _... __._w .... 47 - tl!! Mit!i.TC3'SCyo.
WRSK4:C�'� t�QTc
C�,l sti
oo •'S � �o a c� 1 {
_ e -+•,°To, �°,_�=__ ��____-- -.+.� —_ � { _ it��aOta.Y"�"tQN F°:Rt=1
r ABSORPTION BED END SECTION
� s
� � •3 a f
W'l - __ ___- __ .._ —_ ..�,. __ ._ �.. FT''.G.f,t,�.rr..�} f^�•,,A_v,.�i�.�+•}r k=' �'�
Q
710 00
C�A
1000
IR
.
ANW
DISPOSAL SYSTEM PROFILE ,x:A1�:�
f '
5 _
.
!
ABSORPTION s
,., N
B ._i0 N BED PLAN
TEST DATE
PF RC RA�iF
! OBS. kfOL F =izC. HOLE
rw
it
CAESNK 5th L LWAN X53
LOT 'Z - SA_ ENA ST. LG
J)6EPH J. 5ak5A41A LLL R`s
HlL. VI�VI ROAD
Dec. 23, M-11
SCALS to 40'
r
3 t '
303
DoT 2
SIOFJ ►�
MEd4, Boot) 120
t4
rwposc-co a
4,6'
t 000 0AL.
s� �� Sir►T�C
tAu�
��►�p� Rex �..'�,
gl�
i
`xt ._: . . •±� *�} app`.:'" .� r
enAL 6T KE6T
L
tC'Ommonnven iii of M�ss�c iusells
Iv AMassac;huseits
8y_slettt 1'utr�Nit� RQQQrd
Sys feni Uhvtiel — — — Syslenl Locdflotn
sc
tlualitily runipeJ: /���g�litli�,
IMe of 1 im!►ing:
Cesspool: No Yes �. ( Se clic I'nuk: No
� !
System 11timped by: l'decddf$ l5Kt'eovjed License#
Gmalenls linnsibmed Io : tirbAter 1,►�Iylrte�lCi i�altll�rr U��iCI
I)sle: --------- ------ ----- LtspeCie
r:
n
Comm nwe Ith of I✓1assachusetts
- �Massachusetls
stem Pumping Record
System Owner System Location
Date of Pumping: t C� Quantity Pumped: gallons
Cesspool: No Yes U Septic Tank: No U Yes L �
System Pumped by: Varede-a 5itL`87�ftma License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
TOWN O J
SYSTEM PUMP EP 4 G RECO
RECEIVE®
DATE: 1
S 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example:left front of house)
^1 C o � OSt
� v
�i
DATE OF PUMPING: ^ G `L QUANTITY PUMPED : MOO GALLONS
I
CESSPOOL: NO YES SEPTIC TANK: NO YES
i
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: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
Commonwealth of Massachusetts
City/Town of RECEIVE®
System Pumping Record APR 2 3 2008
Form 4
j4
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health.0 berlb 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
Important: n ��
When filling out 1. System LtionC �Sl�
forms on the �-
computer,use
only the tab key Address
to move your
cursor-do not City/rown State Zip Code
use the return
key. O
t
S
2. System Owner:
L F C'D c EDCEI�
Name
ISI Address(if different from location)
City/Town State r-7 Q 4`, !�-�'ip
Telephone Number �i�
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) 9-56ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System: to—ti-o—k Q V�'
6. Syste Pu p":
Name Vehicle License Number
Company
7. Location re content we e dis ed:
Signatur ?/06't
Date
t5fomi4.doc•06/03 System Pumping Record^Page 1 of 1
Commonwealth of Massachusetts
RECEIVED
City/Town of APR 15 2009
System Pumping Record
Form 4 T�HEALLT ENORTH R
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
Important:
When filling out 1. System Location: Left front, left rear, left side of hous . Right fron , right rear, right ide f ho
forms on the
computer,use
only the tab key Address
to move your.
cursor-do not
use the return City/Town State Zip Code
key.
_ 2. System Owner:
Name
Address(if different from location)
Citylrown State Y Zipqgr�
Telephone Number
B. Pumping Record
1. Date of Pumping Date- 2. Quantity Pumped: Gallons
3. Type of system: Cesspool(s) eptic Tank Ll Tight Tank
Other(describe):
4. Effluent Tee Filter present? 0 Yes M-K-0 If yes,was it cleaned? Yes No
5. Condition of System:
6. System Pumped By:
Neil Bateson F 5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location whem contents were disposed:
0Q.L.S.D Lowell Waste Water
igna ure of H Or Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1