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Commonwealth of Massachusetts ED
N W City/Town of NORTH ANDOVER t;Li; 0 12014
System Pumping Record TOWN Ot-ryurrlHANUOVER
Form 4 HEAT M DEPAR1' _-NT
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
71 PENNI LANE
key to move your
Address
cursor - do not
NORTH ANDOVER
use the return
key.
City/Town
2. System Owner:
PETER DIBENEDETTO
Name
raaen
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Component
11/21/14
Date
❑ Cesspool(s)
❑ Other (describe):
MA
State
State
Telephone Number
2. Quantity Pumped:
® Septic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
6. System Pumped By:
JAMES H CURRIER II
Name
X SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD Ay
Signatu of Hauler
01845
Zip Code
Zip Code
1000
Gallons
❑ Grease Trap
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
11/21/14
Date
Signature of Receiving Facility (or attach facility receipt) Date
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
REC�IV D
Commonwealth of Massachusetts 2013
W City/Town of NO. ANDOVER U�,a
System Pumping Record TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPARTMtl ENT
GSM
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
VQ
raMn
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
1. System Location:
71 PENN LANE
Address
NO.ANDOVER
City/Town
2. System Owner:
PETER DiBENEDETTO
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping 12/10/12
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
MA
State
State
Telephone Number
01845
Zip Code
Zip Code
2. Quantity Pumped: 1000
Gallons
® Septic Tank ❑ Tight Tank ❑ Grease Trap
4. Effluent Tee Filter present? ❑ Yes ® No
5. Condition of System:
6. System Pumped By:
JAMES H. CURRIER
Name
J's SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD
Signature of Receiving Facility
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
12/10/12
Date
Date
t5form4.doc- 03/06 System Pumping Record - Page 1 of 1
HAUL LIC # 777 $100 1996
INST LIC # 659 $200 1996
NO ANDOVER BOH
TOWN HALL ANNEX
120 MAIN STREET
NO ANDOVER, MA 01845
PH# 508-682-6483
508-688-9540 **
FAX 508-688-9556
Dear SIRS:
STEWART'S SEPTIC TANK SERVICE
47 RAILROAD STREET
BRADFORD, MA 01835
508-372-7471
May 3, 1996
The following is a list of properties that we pumped in your town.
In accordance with TITLE V regulations, we are complying by sending you
the following on a monthly basis, if need be. If we didn't 'pump, you
will not be notified.
PUMP DATE
ADDRESS
GALLONS
04-01-96
197
ABBOTT STREET
1,500
105
WINTERGREEN DRIVE
11000
04-02-96
A
-OLYMPIC LANE_
11000
04-04-96
A
X42.
.71-PENNI
LANE
11000
04-06-.96
492
SHARPNER'S POND ROAD
11000
A
39
HAYMEADOW ROAD
1,500
04-08-96
498
WINTER STREET
11000
187
SOUTH BRADFORD
11000
04-09-96
A
495
REA STREET
11000
04-10-96
A
706
FOSTER STREEET
11000
04-11-96
A
83
CAMPBELL ROAD
11000
04-11-96
A
43
CHRISTIAN LANE(?)
1,500
04-12-96
7
HAYMEADOW ROAD
11000
1577
SALEM STREET
11000
04-13-96
278
BARKER STREET
11000
04-16-96
A
30
BRENTWOOD CIRCLE
11000
04-17-96
A
27
COACHMAN'S LANE
11000
04-18-96
369
HIGH PLAIN ROAD
11000
28
CEDAR LANE
11000
A
121
CAMPBELL ROAD
11000
04-19-96
A
160
BRIDALPATH LANE
2,200
04-20-96
A
200
RALEIGH TAVERN LANE
11500
A
1
GARFIELD LANE
1,800
IV
r1t 1 A
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
!s
! BATE;
l Jti ,
I t I SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
r ( ben -cde-Ao
oti �� ek
6,11 r� r . De c ��
1
If�faa,�• �t' hill iid q i 'til; {. p �,. �,: , 'C.'<I� ... '
PATE OF PUMPING: QUANTITY PUMPED %GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
(PHP � ......
N A►TURE OF SERVICE: ROUTINE EMERGENCY
N TNTS TRARNSFERRED TO: -= f M/PA
OF
I.. Y
OBSERVATIONS:
I •,
1
GOOD CONDITION
FULL TO COVER.
HEAVY GREASE
"BAFFLES IN PLACE
ROOTS
LEACHFIELD RUNBACK/
! . EXCESSIVE SOLIDS
FLOODED
SOLIDS CARRYOVER
OTHER (EXPLAIN)
I SYSTEM PUMPED BY:.. AldV',Dt-
C,
'
J� �^��r1✓!ytlJ X14 i 1 1 Iti I I1,.
,
,'.-�'.COMNIENTS:.
' 1 I-
N TNTS TRARNSFERRED TO: -= f M/PA
OF
I.. Y
4
�cyg -5 7 7
TO: NORTH ANDOVER, MASS T f 19 7L
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! Pr/V/Yi fq/S/�' North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19 - .
A OF
in Ak/k. Sanitarian
cn
V C-64
G/S T F -k
S��NAL SP��
scale: V"40
date: 7-17-75
.y4 4��<
♦':s'ti'r• � ,. J��,'� �,
V,
r
f
ID
w
— ioseph i. barb,egailo, r.s. i weetwrerd circle no. reading mese,
Z.0`
ABSORPTION BED
END SECTION
-12" Mm.ToPsOIL COvr-R
3" WASHZE)PRASTONE W-3180
y"PERFORATED 0%A%GESEaG
It"WASF;ED CRUS HEDSTOb*EWLI'Ii
ASSoR'PTIOti AARSA
z
J
lu
W ._
D�
-ALL
O oN db ' p_{3- i tOCT
F,i
SEPTIC oA� •
OCTV
P40
•
Q TANK : ,. .y ✓ r j 60T. or- r�s0
4.
DISPOSAL SYSTEM PROFILE
R
- 45'
ABSORP'noN AREA
ABSORPTION BED PLAN
0 OBS. HOLE PERC. HOLE PERC RATE
G PERC TEST
TEST DATE
'I.IS .76
PE
TO: NORTH ANDOVER, MASS 19 77
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 o r /S 1''E/r//Y/ `-/I/Y/,. North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19 .
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9�
Abbott Village Estatrs RECE\VED
Modification of a Defvnitive Subdivision DANIEL LONG
Conditional Approval TOWN CiFRK
NORTH ihDOVER
The following informatibn shall be supplied to thp Pian ��Un-` too
to the Board signing the plans to be filed with the RegJUu-1100-1��=DU
Office:
1. A Watershed District boundary determination by the
Building Inspection Department forportions of lois Q'f
and 48 and Thistle Road shall be receivp'1 bv the
Planning Board before any construction can ocovr
within this subdivision.
2. The Planning Board grants the roadway iengLh uaivc`
for Thistle Road (500' required, 1800' shown) haeyt-1
upon the Foliowino findings;
a' The Planning Board has consistantly Eought
the connection of Woodberry Cone and T|`istle
Road for reasnns of public health. seFat�
and welfare, which address the fnllowino
concerns; (]) allowing ranid access b!
emergency vehzc1es, (2) the eztension W
Town utilities into the Abbott ViLlaqe
Subdivision to provide a "loop syotem^. (7)
a\low,the proper dissemination of motor
vehicles from this subdivision to othe`
locations within the Town rather than
placinq all the new traffic load on Abh'/\.
Street which is currently not constroct?d +n
Town standards.
b. The Planning Board voted in its original
decision for this subdivision in 1V95 to
require the connection of yoodberrx /'an- ond
Thistle Road as a condition of app -oval.
The Planning Board feels that existir�i
conditions within and adjacent tn t!/�
subdivision have not changed to any qrr,;
degree to warrant changing the origj"a|
condition.
c. The Town has *ought through court action t|e
utilization of an easement plared on the
subdiviron of Wondberry Lane by the P]anriny
Board to connect with the prooerty which
contains the proposed Abbott QilIaoe
Subdivision now before the Board.
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GILBERT REA
44 Rea St.
NO. ANDOVER, MA 01845
Phone 682.9864
15-A# j)i BENNE,zFTT-c>
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rn Al -P SHEET N0.-U-i�_ ?-ate Y� !�` OF
D7 DATE-isL�iJ--�L,._..
CALCULATED BY
CHECKED BY DATE
SCALE
rNUOUCI 7041nr'ei In[.. Groton. Mass. 01471.
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rNUOUCI 7041nr'ei In[.. Groton. Mass. 01471.
>> I em uwNI;R & AODUSSSYSTCM LOCATION
h ec 6 (mmpI Icfl iron(hou r)
t
U QC OF M
PVMPINC;� � 3 (QUANTITY f'UCD 00
L L�,�1
YES
SEPTIC TANK; NO YES
VATUKE 0F.SERYICE; 'ROUTINE.
•
T EMER0EN'CY
-'R YATIONS;
CU(7D.
MULL TU CUYC12.
rlr YYrC:K>rAsG
:,BAFFLES IN PLACE
LEACHFICLD 1tUNL3AC'K..,
CXCtrSSIYE SQ!✓IDS .
'. FLOO:DED`. .
SOLID, CARRYOVER
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
S1"l'EM OWNER & ADDRESS
%1 /0,4� z
/ o ( 4,251w�
TE"°'�� %F p.i
,s BaA:Rb
f
SYSTEM LOCATION
(example; left front of house)
Oyld r S vn Q t d
ll:%`I'E OF PUMPING: ��� QUANTITY PUMPED � G,ALLO'')
f'
> (,
C l_�.51 OUL: NO YES SEPTIC TANK; NO YES
''ATURE OF SERVICE; ROUTINE EMERGENCY
U 13.SERV.-,kT10NS;
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
S1'sTCM. PUMPED BY:
C.'UNINIENTS;
�. UNTE'.NTS TRANSFERRED TO:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
O' HER (EXPLAIN)
i
i
TOWN OF NORTH ANDUVEk
STEM PU 1
N
-- ' SYSTEM MP
u^ ft��� U RECORD ✓
SYSTEM OWNER � Ap�R�S&
3 SYSTEM OCATION
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DER
-hal `h��
form for use by loca Bo
ba:ubMltted to the.local'Board of Health o oth
... A Facility Infort _tlon
lin TUA
Hi
••J�TWr�an'WQ out ..1.. System Location; .
On
Y^�'f t9b l�e �1 V
• �Y y Address
to move your-
auror-do not
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'•y'ir•i..Y/r tib, Jr }.(�k41'' ••J
2 �!:. ste '•
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Nalile' :q',` :^ ••%•iiyi:+tf''1;':1'.
Address (If different from locUon)
'• `'•, � � . C��OWf1;.':a' . i.:• i it ':i;.°,`; ' f;,• ,
'�• � - �, r' �•Pumpl�g•'Re�•ord • r
MA, SSACHUSFTT
tam Pumping Record m,;s
Slate
state. ZJD Code _
Telephone Number :2 AR76
•rJ�: ` ;,.. J;: •�'Y' fjr, k','j: k'•',.' r/,i(Itr?:J1/1'{C1!.l.,lr�'"' %
r•� I, _�:.,.:1 r . Darn of
pin� ' 'Dale 2, Quantity Pumped: 4,
....• , ' ' ' •. •, lions
(; ' :TYPe 9f.system; , ❑ Cesspools) eptic Tank
❑ Tight Tank
f ('%Other (describe);
4r E,fflu0t Tee Fllter present?Ye
,; ;. i:,;::; �c; ':•�,'- •.❑ If yes, was It cleaned? ❑ Yes ❑ No
... :e; .` ,.,..: •,:'' , fi,,,pat�✓,{li�':I,.ar,. .iyih• �F;,i.ri•., ;;��.
�,;• ��'',��";hil�Fr::'? .;;LralCor>tdl(lon'o(�3y$t: n%';,:.:'';,_, •
.. .. .. .,:':,•y.k^,• ,iij.; .. 'J!M,y;ii:1/,h�r'3�t�' l,r.. r:.bl� ! t +� .:;r,
•• r��41 ,t;rl. ✓'.�p�x,�; i'•�YRR'L�;J�'y �wr ir., ,':,:�` �.i `j C� ,
'i •,i• :i`: {.�`.,;;'• :j',aid'�u/'t^,���'.•t�i�','I'',tlij7y'('i�:
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PompedrBy;.'''`
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, �.,'.�.',, ', i.,,;l •:�y':i�l.:';,)7i!i<'%pr i t ,�jtr� � Yfi'r. t::•i:'-r.
1rln'%
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1 ",'.f.1•F,�','' ::,:7;'.. L'ocafJon.wiiera contents'Were:dlpposed;
:'.. '..��::1:'.'}'`�%.,'•!: ,;I: jt .•/•. :r.�v ':i�'r': r;�'rr t"'i:rl:y ��•��:: ''�': '',
:`,. '1.fv' ti•'.�'.�)i'd 'j•• , �' t Y. •'•bye
of SU
: h4JM4.Mass,gov/dep.water/approva)s/t5forms:htm#Ins
pest
tSforrM.doa!48JQ3 ',� , '
SWOM Pumpin9 Record ' Pape 1 v 1
Commonwealth of Massachusetts
City/Town of NO. ANDOVER
W� System Pumping Record
Form 4
M
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:,
60
When filling out 1. System Location: SEP / 2010
forms the 71 PENNI LANE
computer, useYaww
only the tab key Address HM D�t�M M Nfi
to move your NO. ANDOVER MA
cursor - City/Town State Zi
use the return
not /T
urn P Code
key. 2. System Owner:
� PETER DIBENEDETTO
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
8/12/10
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No
5. Condition of System:
6. System Pumped By:
James H. Currier
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLSD „
Signature
State
Telephone Number
Zip Code
—2. uantity Pumped: 1000
Gallons
Septic Tank ❑Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
8/12/10
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1