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HomeMy WebLinkAboutMiscellaneous - 68 CRICKET LANE 4/30/2018 68 CRICKET LANE 210/107.A-0216-0000.0 I r I Commonwealth of Massachusetts City/Town of RECEIVED w° System Pumping Record Form 4 DEC 16 2011 €€ wM E I DEP has provided this form for use by local Boards of Health. Other fo sQ�0 N*PftM information must be substantially the same as that provided here. Belo ith 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 house, Left rl ht siA�ofse LeftRight side of building, Left/Right front of building, Left/Right rear of building, Un e Address n s/�& City/Town 0 State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Z'1p Code Telephone Number 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 ®'Q`o­- If yes, was it cleaned? ❑ Yes ❑ No 5. Conditiorhof$yste � ` v\— 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locaf a contents were disposed: G.L S. Lowell Waste Water Sign t e Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts = City/Town of i System Pumping-Record cv; l G 2014 Form 4 ,. 7OW,14 ANDOVER HEALTH OEPAR T,,-E IT _j DEP has provided this form for useby 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 house, Left�g side of house Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under e Address LV\ Wck V. City/Town State � Zip Code 2. System Owner. Name Address(if different from location) City/Town q ZiP Code StiC�Q 7 Telephone Number B. Pumping Record t 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system,-YP Y. ❑ Cesspool(s) ptic Tank F1 Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes a<o If yes,was it cleaned? ❑ Yes ❑ Na " 5. Condition of 6. System Pumped By.- Nell. y:Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo "'. ere contents were disposed: /-a-LS. Lowell Waste Water Sig Haul Data f t5fbrm4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record OCT 10 1 Form 4 TOWN OF NORTH ANDOVER 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. A. Facility. Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left/ ide of houses eft/ Right side of building, Left/Right front of building, Left/Right rear of building, Under ec Address City/Town State Zip Code 2. System Owner. C3 Name Address(if different from location) City/Town State Zi�Code 5Y. S Telephone Number 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 0'90 If yes, was it cleaned? ❑ Yes ❑ No. " 5. Conditioraof System- 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7.ISign 4H9ule tents were disposed: Lowell Waste Water Date F t5fom4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth..of Massachusetts City/Town of System Pumping Record Form 4 '4V 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 Location: fomes the c� computer.use vv only the tab key Address to move your C y cursor-do not use the>retum Cityrrown S ate Zip Code key. 2.. System Owner: U V—\ Name Address(if different from location) C � ® Cityfrown State . Zi Code Tele.Pt&hNdm&er TOWN yr NOR7r MENT DO\JER H DEP B. Pumping. Record I. Date of Pumping Date 2. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s) Ly'�eptie Tank- 1:1 Tight Tank ❑ Other(d'escribia 4. Effluent Tee Filter present? ❑ Yes Leo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System:. 6: System um ed Name Vehicle License Number` Company 7. Locatio here contents wer posed:: Signal re of a ler 7 Date http://www.mass.ggvldeplwater/_ pprovalt/t5forms htmAnspect t5form4.doc•06/03 System Pumping Record•Page 1 of 7 A4 RECEIVED TOWN OF " SYSTEM PUMPING RECORD NOV 18 2005 TOWN OF NORTH ANDOVER DATE: '-CA HEALTH DEPARTMENT SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) cpF ej r DATE OF PUMPING: (� QUANTITY PUMPED : 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: f . CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste .. 0 BU F1 4 20 TOWN OF - -- SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) ��Q1/�OI�Cd'� SCS C � a.C-V4- DATE OF PUMPING: I t- 6_ O oL- QUANTITY PUMPED 0 GALLONS CESSPOOL: NO YES S PTIC 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: II CONTENTS TRANSFERRED TO: L Wl, TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED t "� GALLONS CESSPOOL: NO r YES SEPTIC TANK: NO YES �r 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: tour CONTENTS TRANSFERRED TO: Address 6.� �-R�c���' y, A( Title of File Page _ of Date f=ile Open: --- Date file closed: _ Doc Document/Action Title Data of ' action document/ a other Purpose of I�ocume tem jAct of nand note wum. Docu°meet/ doeunv�nt/ --- Action me artment Board of Appeals - Board of Health Planniung.Bo:ard Con seruatiion t✓ommi$Sion - Building Departnlen;t Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner System Location CC(D'�-�C) C"'oCL4 Date of Pumping: r �" L Quantity Pumped: (Sllons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by: �Rt`edaatirlL�(t7idPd License#- Contents transferrred to : Greater Lawrence 8anitary District Date: Inspector: r' T f (`r' L _ c ^•; I 1 79 ' �4 O Alec , 1 r . { .y 1 �ERE{3Y GEQ,Tt�� THAT THE ZVILOIN6 S44*W N ON 7AS P1.Aq 15 LOCATED oN 114E bi�vNv 46 -rHA'T iT GomRxms } '�0 THE 'ZomiNds LALJS C� T�1E GtT �� Y CTowN tS P �, �,tH OF k9rs p SCOTT GN L GILFS u I! L--T, �. — �g �� t��t-t-o t7 t✓�sox t `t ,,. V ►� ►u P.-r., ,E D t 4b g::> L�. �YgT ars tN Ili CFA C. o FiitiM�( � F O t2,. y l A p Va H OCAtil= 1'�a '�Q Dara..; firNAL � � 12 0,►.t k C.G tom_L_a rt o.,5 A s o lflJlw,. .Hlllar �ntst;a Ll Lvt IF ATg } DI ,PROVED,. � AVATI M 0�K �MFI eas�ns� OK 1 1. Distance Tot 1 a. Wetlands b. Drains c. Well 2. Water Line Location jLe 3. No PVC Pipe . ! Septic Tank - - - ' a. . _Tees -_Length & To Clean Ont Cowers. - f b. Cement Pipe to Tank - Cn Both Sides of Tank 5. Distribution Box = f v l` a. Covers & Box - No Cracks Y b. All Lines Flowing &pial. Amounts _ .1 C. No Back Flow b. Leach Field or Trench a. Dimensions b. Stone Doth . c: Capped Ends ' d. Clean Double-Washed Stone ?. Leach Pits a. Di mensi s - ; b. Stone epth ;t• c. Spla Pads ' d. Tees e. C t Pipe to Pit - Both Suedes. f. C3ean Double Washed Stone No Garbage Disposal -FSnaI Grading Inspection i, 10. Barricading Covered System 11. As Built Submitted.. _ - _ a. Lot Lo cation -- b. Dimensions of System c. Location Kith Regard_to Pere Test ss - ,; d. Elevations e: Water Table i9 r :t J G _ ii !.1 C; C)2—lr Sl SUBSURFACE .DISPOSAL SYS�EM CHECK LIST NORTH ANDOVER BOARD OF HEALTH APPROVED DATE PROVIDED DISAPPROVED DATE TIME REASON , Tit e 5 Reg. 2. 5 Fail OK e submitted plan must show as a minumum: t�bneo (a) the lot to be served (area,dimensions ,lot #,abutters) (Planning Board files) b) location and log of deep observation holes-distance to ties location and results of percolation tests-distance to ties design calculations & calculations showing required leaching area e location and dimensions of system (including reserve area) existing and proposed contours (g location of any wet areas within 100' of the sewage disposal system o t- disclaimer (check wetlands mapping) (h)-''surface and subsurface drains within 100' of sewage disposal system or disclaimer location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) known sources of water supply within 200' of sewage disposal system or disclaimer location of any proposed well to serve the lot (100' from leaching facility) location of water lines on property (10' from leaching facilities) location of benchmark — driveways - arbage disposers no PVC is to be used in construction profile of the system (elevations of basement, plumbers pipe septic tank, distribution box inlets and outlets , distribution field piping and any other elevations) maximum ground water elevation in area of sewage disposal . s stem plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tank 1__1 Reg. 6 (a) C - acities - 150% of flow, water table , tees , depth of tees , access, pumping, (b Cleanout Ac) 10' from cellar wall or inground swimming pool (d) 25' from subsurface drains %To1?4 .h- Andover Subsurface disposal ,system check list - Page 2 Fail OK Distribution Boxes Reg.10.2a Slope greater than 0.08 Reg.10.4 (b� Sump Leaching Pits ' Leaching pits are preferred where the installation is possible Reg.11 .2 (a) Calculations of leaching area (minimum 500 S.F. ) Reg.11 .4 (b) Spacing Reg.11 .1 (c Surface drainage 2% Reg.11 .11 (d) Cover 'terial Leachin Fields Reg.15.1 Kred reater than 20 minutes/inch Reg.15.1 (minimum 900 S.F. ) Reg.15.4 onstruction of field Reg.15.8 urface drainage 2% Reg. 3.7 (e) 20' from- cellar wall or inground swimming pool Leaching Trenches Reg.14.1 (a) Calculations of leaching area (min. 500 S.F.) Reg.14. 3 (b) Spacing (4 ft. min. 6 ft. with reserve between) Reg.14.4 (c Dimensions 14.5 Reg.14.6 (d) Construction Reg.14.7 (e) Stone Reg.14.1 (f) Surface drainage 2% Downhill Slope a) Slope y/x = (to be shown) (b) y/x X 150 = (to be shown) Pumps Reg. 9.1 (a) Approval Reg. 9.6 (b) Stand-by power ;x R ' Sue, Suwr.Ac.E DisposAL_ Sys-rF-m ._DESIGN of L O T ` CRICKET LN P z E PAFZ-O F O FZ Dr5uv C_ pp 151 ANDOVEr< ST NORTH F-QA.r+K C GE��rv�a� Ar+o Assoc�A.-r�� n LNG�NE ERS ANO A�LLHIT�C.TS r � ' � NORTH ANDOvE..RO�F1L�, PpRK.. i 1�v(� Norz� ►-r Arvpav�Q,M,� ok84s 611 "I'l a A Ric �E LAN Il8� \ _ f t 1 r � I ,e,At � ? , Cc r CGf^.�� � r^•.AR k .. r��t••'J r V! .ter.� .j l. ,Uores �.) No t, or,r, ,jr- •)f ,%-!�F': ~NAL- LL k'-STA,LL--- Ar LAM 1.Ej`G`11i;C A�.�►� titii `:r� IS A ,PLP; 6T L. 100' CF SYSTE-/.; O t'o �r�,rnr DsR+ O; ZALL . ? .s ej .T��L 1376 DESIGN DATA CALCULAJIONS Som OBSERVATIONS By' '-. .. _ - WITNESS -- — - -__. PE RCOL AT 10 N -TEST 110. r ( 1 2 3 4 S7 r -DATE TOP -ELEV4TION BOTTOM- ELEVAZ ION fi t _ SATURATION -MINS. I S f 12" ---►9 D Ro P- M I Ns . 9" --•- 6 D RO.P -M I INS. -- - PERC , RA'TE -MIN./SN. T SOIL PROF+LE-DEEP PIT NO. i 1 2 3 4 5 r DATE 4 - TOP-ELE VAMON , f -TOPSOIL+__ j i 0 --r.;j - SUBSOIL PARE NT SOIL 1� To WATER-TA9LF_ l �N�+iiK r d WATER TABLE ELEVATION / Fl + BOTTOM ELEVATION 1 7 9. 5 I i BUILDINg7-<PEI ► /t B.R.,oR xGAL. (UNIT = 6,00 GPD FLOW GPD Flow x GPD USE I CQn GALS EPTIC•TANK LEACMINCr AREA BED• 04 G-PD Flow x , . 5 SFG-AL.= SF BF.D USE qoo SF PITS_: TYPE .MFR, (TYP,) SIDEWAI,,L AREA _ SF x_ _CrALS.1 SF = GPD BOTTOM AREA SF x___ __GALS.] SF - GPD I TOTAL PIT LEAC1-IINq• CAPACITY _ _ _ _ _ _ _ _ GPD /PIT I GPD FLOW ;_ ___GPD/PIT=__ _ PITS RE4D. USE'_PITS � tF_NCHES A SIDEW L AREA _ SF/LFx_ —GALS ' $F = GAI./LIN.FT. BOTTOM REA SF�LFX _ GALS/SFa �GAL,� LIN.FT, -TOTAL.-ME K LEACHING CAPACITY GAL,/ LIN.PT. ?D FLA�t.-- Gal �L11J.PT.= t,.I`.TRENCNES REQD. USE. L. NOTES : _ E i - i �L�VITT SDN• SG4��DUL�c mat 4 FL up►ppb P;oe _ NOTE*. ALL ELEVQTtONb Q,er-e¢. To IbO-r-rOM ;Stv- ,e- TANW. IKLAT OFM PtVL- (tNvp-v-l) C, �EPT1G T&MK O%xr"T Pi rr- G PiN. GFLAflE Ctz H c�iusF- H Ftm. G- zoaE 4/ I ' - I-'- 4 .4 ' I, F i r4a PEa Ff d - ----- 4 C D E .A 4' PER.>=o¢dTED C3tTUMiND+JS F 3 FlCiE2 PIPE (CAPPED G.NDt•) /K/N. F/YE JlIT,L.ET � f 20MIN. F D FO" —- - PEs2V02 T M014- E 2 T IrD A io O LEALNiNG Oip LIMIT LINE. LA PL & M oF- Lc-ac-UtHo V5ev N 0 SCIAL-S F , E►J�.. v r1R1` `RICKET �.Nl '37 OFF X74 LO? F fGTE ' ��tL �►_t YA', t ►•• T-ZF F'Lur.1 � �5 1 ''�`' :�W� L iF-7 73 _-E PT 1.. /-\N < . rN SET j 18733 �. t �>✓Tlc -TANK CUT'ET �8�7•C8 i { i DIST 8 :; k -I'7,14LT7 rfl688 E 15-T Fj C�;. G B oTTC Nf O>r 2E-,-) .50 i - i f. ACCESS MANHOLES TD WaHlN 4 � op r-iNI%N G.ZADE i a r � -.-Ati"ER UNTREATED !? _ -` 4 ,C.'L'TEES �.�� � � t BUtt_OtNG PAPER . F i .02 M A.--�- i COVE tt --- - - W --- ---- r }_ �r F ` �D I ST. -- ---� 1, - _ ! 2 - - - � Lam--.T_ ._ � Y. 14.SZD GAL. ' SEPTICTr�W1�• � + ' - G ALL STotvs y"^LL i r a� 0 too Sc:4,Lra. *- RO :SCct4emATIG. ONL`! - AOR SI'T'E L.AyoU-r t SeE TPC- - i i FINISN GQADE �GQA65ED 11RTa -�` �- - 4• PEWFOR-ATED r5%T. PIPES i t COtf£R LOAM � \ � t2" MINI. i re y2 a 00 STONE •••.�•• •i••��•.ti=1•i=•• •{ ••� �i«mow••;•= '•i• =•S•�=�� ••• ; *.Pip I .errs • + I I' -- -- — • • •I•• ••••• �j•• • • • . + • tel• • s 1 V2 STONE O A.J S N 4 .•,�.� '!. ;+ i:��"l,�-¢C �o S.. �}� � '� � i `�• � !. .Y.-S`� w'�Y � G y _ G A E A D _ i t C2OSS SECTION of LE- aCUII� G 131-0 a - NO SC-&I-ft A NOTE: eLL STONE- TO tSE. WA SkE•D Jud SusLr-Ac.E DISPOSAL.. SYSTEM DESIGN oG LOT CRICKET LN +`;S C U14 1 D(I IV PR EPAfZ�� F O�Z �' 51 AX10o v uf,, -r NORTH AN, r-`!f-_--I-, / I Y:V-A -Aw- C GE_L�NA�s M10 ASSOCIATES r ENGINC�E.RS ANp ARCHITECTS `v�' No2.-r►-+ Ar�oo�.�cz,MA o�8g'S I r ' i R E'41 L r) jy v 1.1 L. I L- 1 .1`7 1 1 LA" Ck APA. './ r1 ci. . �M=l„ AVn a� ` • �. .oO. i t .•`. / I ,1 ,1 s ./ ILs, r Q i C� �- r� - f cr No T'E•s N0 6.7,r G.� r rrr �i�•.' �E^i SAALi l ti ST,�LLE 1 �- l�Lh���1.•' Lti A', 1f'l L or 4 1U0 S� k('Fl `: �YST�j<+ D_E.S1GcN-DATA CALC_ULAT IONS s IsOiL OBSERVATIONS BY WITNESS PERCOLAT I o N -TEST Ro. 1 2 3 4 ' S DATE --TOP ,ELEVAX10N r BOTTOM- ELEVA"T ION t SATURATION -MINS. Jr 12" --►-9" DRO P— MINS , r - - �— t — 9" PERC - RATE -M►>1./=N, -� 7_Ig3011 PR,OFVLE—DEEP PIT NO. _ I 1 2- 3 4- DATE DATE i t --- STOP-ELEVATION - -TOPSOIL SUBSOIL F t PARENT SOIL WATER TABLE /' 4 t + M i I WATER TAF3LE ELEVATION BOTTOM ELEVATION BUILpINCz-1zCPE _�n'ti� �,1-Ir! rr `.-� GAL. JUNIT r GPD FLOW Q GPD FLOW x ISO7- 9 CG�._GPD USE I C,GC) GALS EPTIC 7ANK i i LI=ACHINGr AREA QED 00 GPD FLOW x 5 (;F/G-AL.= goo SF 8EM USE qcc SF _PITS_ TYPE MV FC. (TYp) SIDEwAAL AREA _____�SF X _ _ G-ALS.' SF = GPD Bo-rTOM )REA _ .. SF x� GALs.� S1= GPD TOTAL PIT LEac+aING CAPACITY _ _ _ _ _ _ GPp /PIT —.- - -_GPD FLOW :__ ____GPD/PIT=_ PIlS READ. USE,. _PITS lltENCHES SIDEW l AREA SFILFx- _ —GALS = GAL-ILIWFT. BOTTOM REA _ _ _ _ , SF/lF x _ GALS/SF = _ �_GAL./ LIN.Pt -TOTAL7PtEN LEACHING CAPACITY _ _ _. GAL LIN.fiT• GPD FLAVA -- GaL�Li�1. .= L.P.TRENCNES NOTES : _ PAG E 2- 0 F 4 - CKET L,ni SO' OFF -7 it Lo? � } � PSOTE ' 1.k Tzr'E_ N%4 s' CF • IjWF L 1�3'7 73 �EP7I� -TFNI< LN LET 18733 S _PT 1 C AN K C UT LET - - + 187.t8 f " D15� c'. ,� TN L c.T E 15-T r �:k G 1:30 TTo M OV- 9 I0 f r ACCESS MAN HO LES TD W I-T H i N 4 O F F t mt%t4 gR,DE w � I � A-"C' -r TEES UI t)ING�F,c��REG i`t ----T-1 I _ 4"C-T.P I RE T. t �2, AAIN. COVE12 sz -- - COE _J --- (DIST -- `"I `gib, SN --� ,�,,� f � I � � I _Q► � .� - 'd C/ 1I `�` GAS.. SEPTIC TAtJIc' G F F ALL STONE :Z"ALL U DE WASNF D . !G ' 45' A `_ �P ICA& IEAC�1 M t=D PROFILE -- yr I�U�f :SC4-EEMF�ITIG pNIY - �t� S(TE LA`'/OUT � SEE �P�, I a • i Ml 3 FIPiWA GRAPE (CCLf bEP AMS4 /j -4` PERFoSL.ATE© iS%T. P1 PE COtIER R LOAM I'2�' i�ltM• i i . •t•:• • •• ••� •�� •M �• �•+• .����•I• • •hr � • • ••f ♦ •fes �Vrs � STONE •i�•��• S••it_'�• •.f•«.•�..1• •.;' •,r �� •• j• ` _ a 1 V;C STONE �� a COARSE SAHD CR-oSS SEECTION or- LC- &CutHCv 13E-0 NO SC-&L.E { �t NOTE: &I-L STOME TO ME. W'A t),U*-D OZ�1 - t 4- • R Stc? �n 1.bQ i Q`� ,.I ��'I'V7 C✓' < C7ili� o7 a' a- l j a of ' t VIM ► -� 1 l ,`v sti ��r��� L VI1 oTNT`�dTJ-Nr-'r 9v 1loos O j4 I-VI iL, aNNI Mfv*tO is 9D 6t4rMA9 3ttl.No Q3J.b�o'1 5� t*+b'1d 51rt1 h0 hMot�s �a 1 ` V l V , I f c , 6L I k� Nr � 1 V i II J ' L /h 1 79 ' �s q _ O 6 ol Am fi {-EE2Ej3Y GE>zTl�`( TNA" THE 'BVIl.OINdo S�vwta om THIS P�.a�l IS LOGo.TED oN-n4F- btz ou NO lib 4�OW N AND -NA'T VT GDMVVW6 3 n INE -LOt.1INds 1-4wS Gl� TM GITY''[owN dF , rr VAIA OF w1g"14,y SCOTT L r^ GIDS"- ..� - C J ,/�- r r �1c T l3�HSE e61,10I�-�1 E5uiL , I-r7 It1OFM�� FRANk s �yG p`:o 1'388 40 ` � o ss/C11A1 ��� >= QAniK ���t,.�rrn.S ASsvcte.TES N Gt NE>✓2S� At2G.�-t tT�C.T"S C � N 17' i 1 A7 � 1 r r 1V � s stir 6'ac ti 9 1 1� 1 r 2/� v 1 L.-F.VA-r 140 . 1 K V PIPS our OF NGE. `6S 1`6 —r 1 - WS1 MP MM(2t=rANV. hs �J V —c.�' U �'�uGE. 1' 'G�►:aAL.» OF Mas. d► > a 1 t>oVE.- F ANk c� F!{cs C. pr;o 3$ o Scn,LE I " = D.arE NAL��� F RA t� �j ELS i.l AS A S SvC ti.caTES F--- NC�iNEE2S> AS'dC.!-(tTEC.T'�3 Uut m' II i e °oa IM I kA n qc _-io L-L I W U V' ; z I N\A s�Z wl J 1 L.F.VAT t a N'S. I P1V PIPE OUT 01=NSE. 'ba, 16 buiLl"T I AIV- PIPE INTO-DhA.4IL . I� C7 V UP.�'� D 14b PO—O%A6= I N 121 VE I WTO D.15OX `T 'i°�G.► -' 1r4y, PI PE OUT Q.5ox F RANk C. .o0D'Aor ��Q4 5G4LE ► \�SSIpNA!�N6� �� � �0����� Y� ol � I r � 17' r � Ah J! '►➢ ���¢ �g� ���LLQ ; N 0 .o'k It m 3. Mme( PIPE929-T-OFP5E � A� u ! L 1 I El Pr- 1NZp-qi,9 - I pl,-1 s3v RPE CUT o 1 SPE i `7 Liv.ice,rS 12t IT D FSOx -c►+dF,y�s moo? FRANCS F c� C2 N . A ,pro. � o ca CA,LM I E-=; 'Wei ZZ, ISO s/ONALE� FRANSC G�>�Ltt�t4S S ASSVGIATES IL Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record NOV 13 2008 Form 4 Ee'a ^< #.-NORTH ANDOVER DEP has provided this form for use by local Boards ofl>tiaibtiern�ly bf used, but the information must be substantially the same as that provided ere. Before using tnis 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 ght front, right rear, l ht side of 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) City/Town State/'ti Telephone Number B. Pumping Record l �- 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: 0 Cesspool(s) _ eptic Tank 0 Tight Tank �] Other(describe): 4. Effluent Tee Filter present? 0 Yes — No If yes,was it cleaned? 0 Yes 0 No 5. Condition of System: V\ _ L V 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio here contents were disposed: L. Lowell Waste Water igna ure of H Or Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts ° CSIVED City/Town of OCT 3 0 Z�J9 System Pumping Record Form 4 TCHE �R 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 tQ determine tate form they use. The System Pumping Record must be submitted to the local Board of Health mother approving authority. A. Facility Information 1. System Location: Left side of ho e, Righ s e o front of house, Right front of house, Left rear of house, Right rear of ho a rear of building. Right rear of building. Address Cityfrown State Zip Code 2. System Owner. Name Address(if different from location) City/Town State&g,, ` de Telephone Number j �' 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 to If yes, was it cleaned? . ❑ Yes ❑ No 5. Conditio f System: n� 3 (eve 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: L_S.D Lowell Waste Water 16, Signature of Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 401 GM SvOY DEP has provided this form for use by local Boards of H al�q& 0 fik A We sed, but the information must be substantially the same as that provi 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 front of house, right front of house, left side of hous i ht side of ho , Left rear of house, right rear of house, left side of building, right rear of building, under deck. CityfTown State Zip Code 2. System Owner: v Name Address(if different from location) City/Town State/^ � Zjo 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 2 No Ifes was it cleaned? Y ❑ Yes ❑ No 5. Conditjpn QfS�steem: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Locati where contents were disposed: S.D. o II Wast er Signatur of au r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 � Commonwealth of Massachusetts RECEIVED City/Town of OCT 2O 2012 System Pumping Record TOWN OF NORTH AND ,� 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. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left ht side of hou , Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address 6 � �� City/Town State Zip Code 2. System Owner. Name Address(if different from location) City/Town State Zi Code State Number B. Pumping Record 1. Date of Pumping p g Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes to 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. Location where contents were disposed: .L S. Lowell Waste Water SignHaule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1