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HomeMy WebLinkAboutMiscellaneous - 700 CHICKERING ROAD 4/30/2018 (7)I n�p 0 (n K r (D 0 K1 LZ O 01 A) (D K Q (D -- h7 O K Eg (D K r x (D K rt P) 1m ■ Commonwealth of Massachusetts w W City/Town of NORTH ANDOVER, MASSA System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. r HAttfil" TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 1. System Location: Address A AAAo-,/er _ (y) 018 City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Stan Zip Code 6--s _ (w'))- l SOD Telephone Number 5 7 -off 2. Quantity Pumped Date GCease. Cesspool(s) Septie Tank 4. Effluent Tee Filter present? ❑ Yes 9 No 5. Condition of System: Wr1 6. System Pumped By: Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes g No 0k -e. W i5or\ H q 015 Name Vehicle License Number iv�r Lt^nnmP_gl_._ Company 7. Location where contents were disposed: Signature f Hauler http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect Earth Source Inc. t5form4.doc• 06/03 1950 Broadway Raynham, MA 02767 5 - Date System Pumping Record • Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, May 22, 2012 5:46 PM To: 'zedros@hembar.com' Subject: I. R. - Ashland Farm - 700 Chickering Road, North Andover Importance: High To: Betty Zedros 617-557-9753 Dear Ms. Zedros, Per your request for information today regarding any complaints regarding the Ashland Farm facility, I reviewed the Ashland Farm file, and did not find any history of complaints for this location. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg. 20 1 Suite 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com