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HomeMy WebLinkAboutMiscellaneous - 646 FOSTER STREET 4/30/2018 646 FOSTER STREET r f�:\.1210/104.B-0008-0000.0 s 1-N Commonwealth of Massachusetts City/Town of hAR OC 2014 System Pumping Record NORTH ANDOVER TOWN0FN—R;HANDCM.: Z Form 4 HEALTH DEPART 1'-Ion' ..�� 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the computer,useonly the tab key Address to move your cursor-do not City/Town State Zip Code use the return key.m� 2. SysLREW Owner: 1�I _ Name Address(if different from location) ----- - ---- City/Town S4Teleph tZip Code Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): ---- - — — - - -- 4. Effluent Tee Filter present? ❑ Yes VNo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Syste / 6. System Pum ed By: Name Vehicle License Numbe Company 7. Location where contents were disposed: INWIR Ipswich, MA. Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Form 4 -- System Pumping Record Commonwealth of Massachusetss Massachusetts - System Pumoina Record System Owner System Location All,irr r d?d'.t aL Y H(-vtE a., V for ::t: h i en ,ndo-/eor A% 011" It.rth %ndovor. 9"R) -6H9-8`)44 v 1r i..• Aadrrw• Type: Emergency Routine Cesspool: Nlo Yes Septic tank: W Yes Date of Pumping:T G I•p Quantity Pumped: r(X;, Gallons System Pumped By: Wind River Environmental LLC Permit 7t: Contents transferred to: Contents Disposed at: Date: 3',Z(-o'Z- Pumper Signature: Condition of System/Other Comments Dep App+oved from - 12/07/95 AddressT, ,f- Title of Fide Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer toother Purpose of Document/Action and notes. action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planniing Board — Conservation Commission — Building Departmer t_ Form 4 -- system Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record System Owner System Location An lrov P"r r ni Andrew Gds F"ostc•r .* 616 Fest 1t St N Andovor 14A 01845 14 Andovcr. MA 01445 i l i�, 688-8->9-1 k9781 6.-t-d594 Type: Emergency Routine Cesspool: No F:✓; Yes Septic tank: No OYes Date of Pumping: (I�-.E)-3-C) ( Quantity Pumped: f 50 ) Gallons System Pumped By: Wind River Environmental, LLC Permit#: Contents transferred to: Contents Disposed at: G.—L Date: Pumper Signature: Condition of System/Other Comments Dep Approved from - 12/07/95 C lLJ FORM 4-SYSTEM PUMPING RECORD RRI E R SEPTIC chi DRAIN SERVICE 107 FOREST STREET; MIDDLETON,MA 01949 . (978)774-2772 COMMO EALTH OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: r s �� SYSTEM LOCATION: DATE OF PUMPING: ?-9 7 QUANTITY PUMPED: GALLONS CESSPOOL: NO F7 YES F SEPTIC TANK: NO 0 YES mm Lg- Sy STE MP PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE: y`t �� INSPECTOR: i OWN OF NORTH�Ae'.!�0° €tl iiLTi� f ' — 61999 TrIC P8.)i ESSIONAL EXPERTS IN ThE SEPTIC ANL' C•iiAIN viOUSTAY �0 FORAZ 4. SYFMI PUMPING RECORD N OF NOp1 H� tp,DtN OW goARD Commonwealth of Massachusetts SSP 61995 •assachusetts yskm Pumping,Record •stemr _ ystem Location MT Date of Pumping: 0 - QIr— uantity Pumped. gallon /�/ Cesspool: No i Yes ❑ Septic Tank: No. ❑ Yes /S. SystemPumped by: .............. .. .. . ......."............•.............•........ . License M ................................................................. Contents transferred t D; Date Inspector 107 r msrst ��0 FORM 4- SYSTEMPUMPING RECORD Kidd)OM NIA 01949 5�Q S,C .. mmonwealth of Massachusetts D Massachusetts System Pumping Record - System \\mer ystem Location \2 a l�� G 14 A- /. S�� / Date of Pumping: &� t 4 �� Quantity Pumped: !Cv-�' gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by: L- License 4: Contents transferred to: S / Date / q �, Inspector �: Form 4 -- System Pumping Record Commonweakh of Massachusetss Massachusetts Ij System Pumping Record - P T-r k `. mow Prari...i. Aiidr.-,w Primary Hop 641) Fo.qter S+ 646 FCt.gtNr St Nrwth Arviovn[, Mn, 01841Y Nnrth An(`;-ever, MA, 01645 {478} -663-35{14 n ic478) -688-85C14 x ��r•iSi, A,prl,r�sa Type: Emergency Routine Cesspool: No Yes Septic tank: No Yes Date of Pumping: �3 ttMity Pumped: ,a Gallons System Pumped By: Wind River EflW1W unto% LLC Permit#. Conisnts transferred to: Waste Nater Plant, Contents Disposed at: M . Dale: Ll Pumper Signature: Condition of Systew✓Other Comments Dep Approved Form - 12/07/95 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record RECEIVED System Owner System Location NOV 13 20(6 Parisi Andrew Primary Home TOWN OF NORTH ANDOVER 646 Foct"r St 646 Foster St HEALTH DEPARTMENT North Andover, KA, 01845 Nrrct h Andover, ASA, 0184' 078) -68P 8594 x (978) -68 8—85 94 x Type: Emergency Routine Cesspool: No Yes Septic Tank: No YesV� Date of Pumping: /6 ( Quantity Pumped:_Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments Dep Approved Form-12/07/95 f ; Commonwealthof assac usetts City/Town ofMECEIVED o / We . System Pumping Recor Form 4 DEC 0 8 2008 DEP has provided this form for use by local Boards of Health. Other formsd"y1)b9,lL'sed0M1-th,,DOVER information must be substantially the same as that provided hefe. Before us'rag- tE � eR�t{ r 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 Important: When filling out 1. System Location: forms the `_i,t o computer,use i� 1• T only the tab key Address to move your N., �V., cursor-do not use the return City/Town State Zip Code key. 2 System Owner: ArJf&(✓' rki\S k Name Address(if different from location) City/Town State Zip Code (on Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [/Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes El"No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: was ®axf,�JcC UQ-' Wets /NA- 1 6. System Pumped By: �qs" Name Vehicle License Number W `Y`� Company Ipswich Water 7. Location where contents were disposed: Treatment Plant \ 901938 Signatf oylauler Date • Signatureof Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 . _ s\i�srnrrrrss P"\ Commonwealth of Massachusetts Rt iVSD City/Town of NOV - 9 20 System Pumping Record NORTH ANDOVE TOWN OF NORTH ANDOVER Form 4 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the L 0 computer.use ------ _- ..----- -------- -_.—...__ only the tab key Addressp ©� ,' to move your (�V h nc�QYc.� �" cursor-do not - State .Zip Code use the return City/Town key. 2. System Owner: Name Address(if different from location) ------- -- ---- ---- — -------- City/Town ------ — ---------. State ^-- - Zip Code ---- Telephone Number B. Pumping Record Quantity ,�� —---- 1. Date of Pumping Date 2.� y Gallons 3. Type of system: ❑ Cesspool(s) IBJ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): — ——— - 4. Effluent Tee Filter present? ❑ Yes [O/No If yes, was it cleaned? ❑ Yes [O/No 5. Condition of System: Cao©d ---- -- --- -- ---- 6. System Pumped By: N_j Go 7601 m Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler — Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1