HomeMy WebLinkAboutMiscellaneous - 7 CARLTON LANE 4/30/2018 (2) 7 CARLTON LANE a
210/107.A-0019-0000.0
E
RECEIVED
P-\ Commonwealth of Massachusetts
v City/Town of No Andover JUN 10 2013
System Pumping Record
Y p TOWN OF NUFc`fH ANOUVER
�
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 forms 1. System Location:
on the computer,
use only the tab p/y
nllt:/
key to move your Address
cursor-do not
use the return No andover Ma
key. City/Town State Zip Code
i
2. System Owner:
o -23rle-
Name
Wore
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record 511 2)
�i /UUP
1. Date of Pumping Date 2• Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Erseptic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
U'Nl kuru
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
SteI art's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
A4�arfHau—lerr Date
Sig ture of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
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Nassac�usetts
C�tylNowntof NORTH ANDOVER, MASSACHUSETTS
+:Sy$tam:Purrmpirlg Record.
Form 4
DEP has provided this form for use by local Boards of Health. The System Pumpljng Record must
be submitted to the local Board of Health or other approving authority.
A. Facility Information
I ,UN W 1. System Location:
forms on tt» a L
computer,use
o*the tab key Add
to mow your {
awsor•do rot state Zip Code
use the retum
�y..•• 2. System Owner
Name
Address(if different from location)
ClityRown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Data 2. QuantityPumped: Gallons
3. Type of system: ❑ cesspool(s) Septic Tank ❑ Tight Tank
,` ❑ Other(describe):
4, Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. Pumped
'C� Vehicle Ucense Number
zavF
7. Location whAre contents were disposed:
o HiuDate '.
/O
ht1pJ/www.mass.90vldep/water/approvalsR5forms.htm#4nspect
t5fom 4.dw 060 System Pumping Record-Page t of 1
\R
' ' Commonwealth of Massachusetts
'C4/Town of NORTH ANDOVER MASS ETTS
System Pumping Record
S,:Form 4 `
SEp - 620
DEP has provided this form for use by local Boards of Health. The pin,.jR ord mu
be submitted to the local Board of Health or other approving a t�h4ir, T � T
A. Facility Information -
Important:
When filling out 1. System Location:
forms on the .
computer, use .1%.
only the tab key Address
to move your
cursor•do not
use the return Clty/Town
key.
Zip Code
2. System Owner
Name ---._....__. ..
nen —_— __... ....._
Address(if different from location)
-1t
ocation) - -
C1t7y own _...._ --------- State'-----
Zip Code
Telephone Number
B. Pumping Record
_. 1. Date of Pumping Da -- 2. Quantity Pumped:
Dat; um p Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe): -_ ____._._�_.___.__._...---___.___ -•--•--...-----.-_---.........
4. Effluent Tee Filter present? ❑ Yes [`No If yes, was it cleaned? ❑ Yes ❑ No
r
5. Condition of System:
6. Sy em . umped By:
ame Vehicle License Number
Company •'f1 a '
7. Location where contents were disposed:
Si ature of Nau �/
Date - -
http://www,masg;gov/dep/water/ provals/t5forms.htm#inspect
t5form4.doc-06/03
System Pumping Record -Page 1 of
TOWN OF NORTH ANDOVER
o APPLICATION FOR P-11LAN EXAMINATION
Permit NO: Date Received:"' — 0�
Date Issued:
IN'IPORTANT: Ap licant must com lete all items on this page
LOCATION
Print
PROPERTY OWNER ANDY O ° RPW P N "t-- D I ANsJE [� t
Print
NIAP NO.: 10'I A PARCEL: t-O �_ 19 ZONING DISTRICT: � " �-
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IhIPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
,t/Addition Two or more family Industrial
Alteration No.of units:
Repair, replacement _ Assessory Bldg L Commercial
d
= Demolition
Moving(relocation) Other Li Others:
Foundation only,
DESCRIPTION OF WORK TO BE PREFORMED 6, (? !- Cit= A`U) r-1)P Ke
IDEL L A I -{ ISE PdL H '
Identification Please Type or Print Clearly)
OWNER: Name: ,ANTI t DOLLE- L LIQI E O Phone: Cj �z "(0
Address: L L--(-D-,-3L� t� A'3`10 \1� t2
CONTRACTOR Name: - - - Phone: f
�e
Address:
Supervisor's Construction License: Exp. Date:
f
Home Improvement License: Exp. Date:
�I
i
ARC HITECT."ENG[NEER Name: Phone: t
Address: Reg. No.
FEE SCHEDULE:BLLDIAG PERMIT:510.00 PER$1000.00 OF THE TOT.IL ESTLUATED COST BASED ON 5125.00 PER S.F. '
Total Project Cost :$ G-�^ '1 r) x 10.00=-FEE:$
Check No.: Receipt No.:
11:we 10'4
r
CERTIFIED . PLOT PLAN
PREPARED FOR. SH OF
DIANE & ANDREW O'BRIEN
A T NO. 35773
7 CARL TON LANE
amu.uw
NORTH ANDOVER, MA.
h
NORTH ESSEX REGISTRY OF DEEDS.- BK. 5278 PG. 52
ASSESSOR'S MAP: 107A, LOT 19 ZONING: R-2
SCALE.1"=40' DA 7E7.- APRIL 02, 2003
a
oH. NOTE: SEPTIC TANK &
SET DROM -nn.E LOCATION5 TAKEN
�A CATION
DATED 07-20-98.
SB.
FND.
+o �
,y05 35
Ns
3$CliSah ,L�'i
i
LOT 21 ""'o
UND
44,311 SF.f N0 ire-Pool
34,
00J
J
SEPTIC 1 �
TANK \�o
p D-BOX \��
N \�G
SB. �!
FND.
\�9 SB. '
2J' FND. 235.09'
PK.
NAIL
RALEIGH TA VERN LANE
SET
PREPARED BY
JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS
131 PARK STREET, NORM READ/NG, MA. (978)-688-4899
JOB NO. 5048