HomeMy WebLinkAboutMiscellaneous - 65 EQUESTRIAN DRIVE 4/30/2018 ve
65 E(lUESTRIAN DRIVE
29aD
110� �_�--
Commonwealth of Massachusetts
City/Town of
f
System Pumping-Record DEC •o 5. Z014
Form 4
DEP has provided this form for use,by local Boards of Health. O er 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/Right rear of efhou ,hous , Ig sl Left/
Right side of building, Left/Right front of building, Left/Right rear o ut' ding, Un er
Address
65,-
cityrrown State Zip Code
2. System Owner.
Name
Address(d different from location)
citylrown State [ --,PptCode ;
Telephone Number (P
B. Pumping Record
1. Date of Pumping 2. Quantity Pum
Date ' Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yeas No If yes, was it cleaned? ❑ Yes ❑ No
" 5. Condition of S�rst�em-��
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc-
Company
7. Location where contents were disposed:
�S'. Lowell Waste Water
SignA qt Haule Date
t5form4.dow 06/03 System Pumping Record•Page 1 of 1
r r
Commonwealth of Massachusetts
= City/Town of 013
System Pumping Record �a�1
H Ui
Form 4 ` -,W:zII
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 house, Left/Right rear of hous gpe . right a ofhouse LeftRight side of building, Left/Right front of building, Left/Right rear of , Under deck
Address -61
a,�&-f 60-,Aj- XWA�1)&
City/Town State Zip Code
2. System Owner
�eA e�
Name
Address(if different from location)
Citylrown State Zip Code
Telephone Number
B. Pumping Record
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 Er o If yes, was it cleaned? ❑ Yes ❑ No
S. Condition fste7n I
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locat' wh a contents were disposed:
G.t_S. Lowell Waste Water
1)—a _ I a
Sign t e Haule Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth. of Massachusetts
City/Town of
System Pumping Record
Form 4
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 Locati
forms the J1�
computeto \
r,use `
SJP—
only the tab key Address -�
to move your G
cursor-do not
use the return Cityfrown State Zip Code
key.
2. System Owner:
Name
Address(if different from location)
pEC 1 '
Crtyffown State
Ifde
��ytD
Telephone r
B. Pumping Record
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 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System u ped By
Nam vehicle License Number
7. Locati here ontent ere"ed:.
h
Sign ' re o ler Date
http://www.mass.gov/d pIw er/approvals/t5forms htm#inspect
t5form4.doc•06103
System,", mprng Record•Page 1 of 1
TOWN OF P ,
SYSTEM PUMPING RECORD
DATE: (�
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example: left front of house)
C�
DATE OF PUMPING: QUANTITY PUMPED :
GALLONS
CESSPOOL: NO YES SE 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 OTDER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: / -5-0
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
�,T+ -,- jr
DATE OF PUMPING: Q QUANTITY PUMPED U� GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES —Z
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.
COMMENTS: C'
CONTENTS TRANSFERRED TO:
�� S
Address L GO CS14N-Al' Z)f a Title of File Page 9 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 - Planning Board - Conservation Commission - Building Department
Commonwealth of Massachusetts
OoO k P rL d oye it , Massachusetts
System Pumping Record
System Owner System Location
Date of Pumping: q/l /O J Quantity Pumped: gallons
Cesspool: No Yes Septic Tank: No L..J Yes
System Pumped by: Fettedoa it ntoea License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: _ Inspector:
i
t�
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having
have been obtained. This does not relieve the applicant
land/or n
landowner from compliance with any applicable local or state law,
regulations or requirements.
I
****************Applicant fills out this segtion*****************
APPLICANT: 77/3 wo�IG,
,f Phone QIX—77S0
LOCATION: Assessor's Map Number Parcel
Subdivision �a �rfa�ijs� �� ��+ Lot(s)
Street St. Number Gs
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Da
Conservation Administrator to Approved
Date Rejected
Comments
Town Planner Date Approved
Date Rejected
Comments
Food Inspector-Health Date Approved
t Date Rejected
/ic Date
Approved S t �1:DateRejected
Comments
. //
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
Date
.�- � � - ,. _F - d `4 .. w . .Cys)• w-•'�
it
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w�.�r a G PLAN
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DATE' 3 e'" ar t
SL SX-E. R.L.S.
LAI�YRENCE"a-.NORTHaANDOVER- . , ,
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/-CERT/FY THAT THE OFFSETS SHOWN ARE FOR THE USE OF
OFFSE TS SHOWN THE BUILDING INSPECTOR ONL Y, B SUCH
CaYFORM-TO THE USE IS FOR DE
TERM/NAT/ON OFZON/NG
x ZON/NG�BY.LAW OF CONFORM/TY OR NON CONFORM/TY
Taj CLTsI-1 "✓bov�.
WHEN CONSTRUCTED -
CERTIFIED FOUNDAT/ON PLAN
LOCATED IN UomTK
SCALE.%1"
S.L.GILES R.L.S.
L AWRENCE a NORTH ANDOVER
v
LST 22 b.
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� 4� � ESTid. IA.J �IZ,IVE
/ CERTIFY THAT THE OFFSETS SHOWN ARE FOR THE USE OF
OFFSETS SHOWN THE BUIL DING INSPECTOR ONLY a SUCH
ly-
CONFORM TO THE USE IS FOR DETERMINATION OFZON/NG
� � o. 13yr2 � •}>
ZON/NG S Y L AW OF_ CONFORMITY OR NON CONFORMITY
WHEN CONSTRUCTED ht, �,��;,tt. •��
CERTIFIED FOUNDATIONPLAN
LOCATED IN 1Jo�zrN ANaou�s�
SCALE.%
S.L.G/LES R.L.S.
L AWRENCE B NORTH ANDOVER
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/ CERT/FY THAT THE OFFSETS SHOWN ARE FOR THE USE OF
�4
OFFSETS SHOWN THE BU/LD/NG INSPECTOR ONLY B SUCH
CONFORM TO THE USE /S FOR DETERMINATION OFZON/NG ," �, 0.
��' ~'K
ZON/NG BY L AW OF CONFORM/TY OR NON CON
- FORM/TY
WHEN CONSTRUCTED ,JF: { •s
CERT/F/ED FOUNDATION PLAN
LOCATED /N QJ 7r k ,2 bo urt,
SCALE-711- 4' DATE' III 8
S.L.G/LES R.L.S.
L AWRENCE a NORTH ANDOVER
41, 184. a;
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/ CERT/FY rHATTHE OFFSETS SHOWN ARE FOR THE USE OF '' OF
{
OFFSETS SHOWN THE BUILDING INSPECTOR ONL Y, a SUCH
ue.
CONFORM TO THE USE /S FOR DETERM/NATION OFZON/NG �''
. �i�
ZON/NG B Y L AW OF CONFORM/T Y OR NON CONFORMITY ����
,j3 ki
°J"2�"1-k A h iDoc m WHEN CONSTRUCTED : '•JI,r
13D op HFOI.III LOT 22-- 65 v E5Ti��,5;
(,vq�Et� Sc�Pr 7 Q rbWrJ ❑ UJEU- APPRO uED \1
S5 56prlc Sy STE4,1 pE516,.j
�ppl-�o\j 15D �Ar�' /�Pr�v�NG /SunyoR�ry
l
CO/JPlTiays_
DI,i4PPP4VeD D�iE
R�4SoNS
D� st'PT't C SYSTEM 1�SQA LI..QT�o�1
EXv4T(O,,�J ►10&j D�rG Cl 1945S p F4 L-
FINAL I1/5pecrlon)
APPROVEP �i�TC It-�-k� /SPPi�v►�v� A�r+tor�i�y
DISAPf'IZdvFID PArE'
R�05o NS'�
FwAi. /JPPRpVAL DArE �-z2- �
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BOARD OF HEALTH
No.Andover, Mass . ,
" SUBSURFACE DISPOSAL DESIGN CHECK LIST
LOT
APPROVED DATEI, — / t DISAPPROVED DATE t -7f
Provided: C Reasonss
Title V FAIL O
Reg 2.5 The submitted plan must show as a minimum:
a) the lot to be served-area,dimensions lot #,abutters
blocation and log deep observation holes-distance to ties
c location and results percolation tests-distance to ties
d design calculations & calculations showing required leaching area
(e) location and dimensions of system-including reserve area
f) existing and proposed contours
(g) location any wet areas Athin 100' of sewage disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easements within 100' of sevage disposal
system or disclaimer-Planning Board files
(j) known sources of water supply within 2001 of sewage disposal a
system or disclaimer
(k) location of any. proposed well to serve lot-1001 from leaching facility
(1) location of water lines on property-101 from leaching facility
(m) location of benchmark
(n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
(q) profile of system-elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
- Otter, elevations
(r) maximum ground water elevation in area sewage disposal system
(s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capacities-15U of flow, water table, tees, depth of tees,
access, ing
(b) cleanoutpump
(c) lot from cellar wall or inground sulmming 'pool
(d) 251 from subsurface drains
Reg 10.2 7 Distribution Boxes
(a) s ope greater ME 0.08
Reg 10.4 b) mup
i
•. Kg
f,4;e Design Che_ ListPage 2
x
FAIL CK
Leaching Pita
Leaching pits are preferred where the installation is possible
Reg 11.2 a) calculations. of leaching area-miniaam 500 sq ft
11.4 b) king
13,10 a surface drainage 2%
?x.11 d) cover material
e) t'z2'x4" splash pad
If) tee at elbow
g) no bends in pipe from d-box to pipe
LeachingFields
Reg 15.1 a) no greater an 20 minutes/inch
b) area-minimum 900 eq ft
15.4 c) construction of field
15.8 d) surface drainage 2 % r
3.7 e) 201 from cellar wall or inground swimming pool
Leaching Tesuches
Reg 14.1 a) calcucula ons or leaching area-min 500 sq ft
14.3 b) spacing-4 ft min 6 ft with reserve between
14.4 (c) dimensions
14.6 d) construction
14.7 e) stone
14.10 f) surface drainage 2%
Downhill Slone
A) s o e y x - M be shown)
b) y/x X 150 = (to be shown)
s
Reg 9.1 a) approval
9.6 b) stand-by power
Common weal tIt of Massachusetts
Massachusetts
System Pumping Record
Systent Owner System Location
Date of Pumping: l �`— + 9 Quantity Pumped: gallons
Cesspool: No M' Yes U Septic Tank: No U Yes tA---'
System Pumped by: Faredea gov�ided License #
Contents transferrred to : Greater Lawrence Sanitary District
Date: _ Inspector:
TOWN OF
RECEIVED
SYSTEM PUMPING RECORD
AUG 17 2004
DATE• �`'/ 3-0y
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example:left front of louse)
4e 4:53�
(�o45-
l
DATE OF PUMPING: 3 -OL(- PUMPED : v GALLONS
CESSPOOL: NO 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:
CONTENTS TRANS ERRED TO: G.'L.S.'D Lowell Waste
�' Cuu+u�nll�rta1111 of AiAR��lri�uiells .
� Nlnssncltusetts
Bj'il»1T1"titClto 5j'il'eni LnciiMl
cl US 1r'►G vI r.
ev) 4� ;
�. A ( .
�
/
uate or NumoslIp 1/19 I -! (P/
Cessliuuli n�� � � 1'e! _� firt,ll� foill•i 1.4► yes 191
Q,�"eS �
syslelll i'uugiet, by; (, ^ License NI
Cunlenls IrnnsleirrJ Ir:
uale Illsp�rlut
r
Commonwealth of Massachusetts 3 _._ VED
City/Town of ± 0 DEC 2008
System Pumping Record 4
Form 4 01lV,4 6r� NURTH ANDOVER
riQAt-TH 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 re , eft s�ofho . Right front, right rear, right side of house.
forms on the
computer,use
only the tab key Address
to move your �1
cursor-do not
use the return Cityfrown State Zip Code
key. 2. System Owner:
_- -- Name
Address(if different from location)
Citylrown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: Cesspool(s) 0--Septic Tank 0 Tight Tank
Other(describe):
4. Effluent Tee Filter present? E Yes = No If yes, was it cleaned? p Yes No
5. Condition of System: � �/
(\\C) � —Azo-�
6. System Pumped By:
Neil Bateson F 5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
Lowell Waste Water
J-
t;ignafu-re of H u r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts RECEIVED
02
City/Town of
w° System Pumping Record DEC 15 2009
Form 4 TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. Othe! faims may 15e used, but thle
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 Locati eft si eo � Right side of house, Left front of house, Right front of house,
Left rear of h , igM rear of house. Left rear of building. Right rear of building.
Address
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
c0�- 1
1. Date of Pumping Date 2. uantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes �O 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. Locati re contents were disposed:
L .D Lowell Waste Water
g to a of Haul r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
i
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4 r+Q 4 2010
DEP has provided this form for use by local Boards of Health. to@YMY ut the
information must be substantially the same as that provided he d1dampheck 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: eft front �1io�+c 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.
City/Town State Zip Code
2. System Owner:
Name V
Address(if different from location)
City/Town Stat//'1 �`7 e
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes (]-moo If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: � p
6. System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Locafign where contents were disposed:
.S.D I o Waste t r
—cr
Signat a Haul r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1