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HomeMy WebLinkAboutMiscellaneous - 66 PENNI LANE 4/30/2018 (2) _ 66 Penni Lane Ii. , Commonwealth of Massachusetts C,ty/Town of 4 &1'ev'1A System Pumping Record I RE61EIVED7 Facility Information: vlz 1�5 ?M TOW vA F NORI H AN�Dj NO 09VER '4T LHEAL M DEPARTiltiz NT System Location, _Jko P.�nnl L6h_4_ Address "J-m 114 R_ 6 oq!�- C,tv/Town State ipCode S- ysteirn Owner: -, paI L"i Name: Adress (Hf different from location of pump) Town State Z P C od Telephone Nuinber raping Record CD Date of Pumping I Quantity Pumped gal lons ype of System Septic Tank Grease Trap Other (What) System Pumped by: Jrnpany.- ROOTER-MAN 46 Portland Street Lawrence. NIA 01843 Location where contents were disposed:...... Signature of Hauler _f______ —Date 9/19/2006 16: 12 y - - L i�iJ Ij t_i iri_i�7V HEALTH PAGE 02/02 Commonwealth of assac uset City/Town of ��M doe. K /� 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 'I. Bystuni Location: forme on the computer,use __ _ y] only the tab kGy Addra9 . � _j,._ to move your — i/ 0-se the - et not –t[�/U ( � use the return City/Town key. State 0 Zip Ode 2. System Owner: /7 Nam--e t ffarent rrom loaati�n) CiiyRown -- _ State dip Telephpn$Numper $. PUMPIng Record 1, date of humping k Date '. 2. Quantity Pumped: V 3. Type of system: 2/septic .,,,� Gell na ❑ Cesspool(s) L� septic Tank ❑ Tight Tank ❑ Other(describe): --------- 4- Eifluent'Tee Fiiterpresent;? �_� �) Yas [] No � 11;yes, was it 01e4ned? ❑ Yes ❑ 'No 5, Condition of System: G. Ittped By: Name ROOTER- N Vetlicle Licensw Number ___ 12 EAST DRACUT ROAD Car na�n METHUEN,MA 01844 7. Locatic??where contents were disposed: Sig JWUN..��-Of Ha ttp,/Iwww.mass.g0v/dep/water/approv�ls/t5 o ms.htm#ins,pect Date $fbrITl4.duC•08,"03 ! �ystem Pumping Record•Page 7 o1 1 Commonwealth of Massachusetts = City/Town of �reec RECEIVED System PumpingZ5rd� JUL 1 1 2005 ' Form 4 41M vy`'v DEP has provided this form for use by local Boards of Health. Other forms;`may .NORTH EuudA ANDOVER the information must be substantially the same as that provided here. Bef re using this form, c eck 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 Locaf n: forms on the computer,use only the tab key A dres to move your cursor-do not ��a��O�,�,/� City n 3� State Zip Code use the return key. 2. System Owner: reb .1�! Name ISI Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Dat las— 2. Quantity Pumped: pan n 3. Type of system: ❑ Cesspool(s) �epficnk ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sys Pumped By: Name d, Vehicle License Number Company 7. Location where contents were disposed: 01 i ure of Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 t � TOW.I OFAANDOVER SEPTIC SYSTEM SERVTCING REPORT Date:_ �� �1 C70---- - ----- - --- -- -- ------- --- -------- Homeowner. : Pumper : 'Ra4er- kPkV\ Street: :_����L Address: �a- )ri\4z-V Phone C>T�p Phone (off' \\P Nature o::' S-.rvice: Routi ie Emerg =y Observations: Good Condition Dill to Cover Bafflas in Place Leachfield Runback Excessive Solids Heavy Grease J 'cr. Roots Other (Explain) Descr:•ption of: Work Comments: AO w.-46V � ,�;z C)r A"Z.1�1 C) bse.y v �� JrceJIY ' / 3, MIU e1s1a�N ��1c:�t9 N°RTS Town Of North Andover Community Development & St 27 Charles Street North Andover, Massachusetts 01845 SSACHUS� Fax 978-688-9542 Board of Appeals (978)688-9541 April 24, 2000 Building The Commonwealth of Massachusetts Department Lead and Asbestos Division (978)688-9545 100 Cambridge Street,Room 1107 Boston,MA Conservation Department To whom it may concern, (978)688-9530 The North Andover Health Department v Health Department recently occurred concerning the appare3 (978)688-9540 Please see the attached agreement for servi and a homeowner. On March 30, 2000 I rr Public Health of Mr. Simbliaris. I was informed that his Nurse should not have contracted to do this work.,- (978) ork.,(978)688-9543 , TO DAT 'IME FR M � AREA CODE NUMSER _�� LU OF � �o �4 EXTENSION . LU W 0" W SI � �NB� RWILL WANTS T � URGE L..vLLRN®�... saCK A0AUi A� PHONED $EE YOUO❑ N AMPAD NO.23-176-400 SETS NO.23-376-200 SETS TOWN OFAANDOVER SEPTIC SYSTEM SERVICING REPORT Date: Homeowner:_�q�` G�.; Pumper Street :_t6 nn Address: 12 raw , Phone 1_b��k' Phone Nature of S•:!rvice: Routine Emergency Observations: Good Condition =� Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Description of Work: i Comments : A DES EGFER'S CERTIFICATION sub-urface sewage S jS -0 No" To-wn Lot No,, —and Tovin I'lap No, install9c,, RP-d S'POci.-Cications 'approved by Bmrd� Of Ile I Thi GO c6rt,r f icat- o--.-i inc ludes t'he loca- tiong kgrades and materials of a!' cofniponents of-" the syste-fill, 10 a Ur JOS PH tiN AS I�V 0 Lt-/v D J. C-) BARBAGALLO 3 No. 464 Note This mist be delivered to the BOard of Health Tithin 48 hours the approving inspac'e"lion. . LAd. _ ♦�-.�, totAM��y r Q` • ' ni i � r t IU_ \ 55a©a L=r{34.flv Cl G, r TO GrM-r � �- `tet TO: NORTH ANDOVER, MASS 3 '�� 19 7G BOARD OF HEALTH FROM: 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 07` 1'6F/V1// 14 /VC- North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 e'er "9C i� eg f ngimeer/R ' Sanitarian o' BAR6AGALL0 c::j A No 464 Q P0c'\C'�ST��. 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