HomeMy WebLinkAboutMiscellaneous - 74 FULLER ROAD 4/30/2018 (2)TOWN OF JVe �rol�r
SYSTEM PUMPING RECORD
DATE:q-t(Q"D o�
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING:'j-4-0d— QUANTITY
CESSPOOL: NO YES EPTIC
NATURE OF SERVICE: ROUTINE
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
PUMPED: S D GALLONS
TANK: NO YES
EMERGENCY
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: V ` r S �� '
OCT 2 5 2001
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD_ _
DATE:
F.1 13039
DATE OF PUMPING: LQ --A3
(example: left front of house)
PUMPED X572' GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
YES
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO: 6 ,, S, o ,
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Commonwealth of Massachusetts
rl lix C— IMassachusetts
Systern Pumping Record
System U Z*S
Date of Pumping: 7 /7 19f
Cesspool: No ( — Yes 1..1
System Location
7(-I r /lam
Quantity Pumped: f gallons
Septic Tank: No Yes
System Pumped by: Fett`e0ort Srler�ftmed License #
Contents transferrred to : Greater Lawrence sanitary District
Date:
Inspector-
N,
L,�rrrilrr►n�rtoil if �f AlaRrttrbu�ett�
muss"ChUSSUS
• �' � . pudrni�}I huirgr.d� I • ����
Dow or i+umosig
Ce'gruult hir ,�� 1'e3 , .
Gees License Ri
system Nlir+red Iw' 7 ` , S•, n
Cunlems Iranslerred It:
- 1
Dalt IilspeClUt ,
FORM U - IAT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 64 ,$ e.f f A Phone
LOCATION: Assessor's Map Number Parcel
Subdivision! Lot(s) I �/
Street / �VLLI-( 4 e WV • Ard St. Number /
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
t��Ljo— Date Approved g
Conservation Administrator Date Rejected
Comments
Town Planner
Date Approved
Date Rejected
Comments ` !
Date Approved
FoodInspector-Health
nspector Health Date Rejected
(/ Date Approved
Septic Inspector -Health Date Rejected
Comments 6,C fOP S�viMn�iwG �oo� /NEf?�i'
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
RE/MAX PREFERRED PRESENTS
74 FULLER ROAD, NO. ANDOVER, MA.
FEATURES INCLUDE:
STATELY BRICK VENEER COLONIAL SET ON A CUL DE SAC ACRE LOT IN BEAUTIFUL
FULLER FARMS. PROFESSIONALLY LANDSCAPED WITH A WELL -MANICURED LAWN.
LIVING ROOM (17 x 13 )
HARDWOOD FLOORS BENEATH THE WALL TO WALL CARPET (NEUTRAL)
DINING ROOM ( 13 x 12 ) '
HARDWOOD FLOORS BENEATH THE WALL TO WALL CARPET (NEUTRAL)
LOVELY VIEW FROM THE PICTURE WINDOW
FAMILY ROOM (18 x 15 )
BRICK WOOD -BURNING FIREPLACE
TASTEFULLY DECORATED
KITCHEN (20 x 13 )
BRIGHT AND SUNNY U -SHAPED KITCHEN WITH SEPARATE BREAKFAST AREA
FULLY APPLIANCED
SLIDERS LEAD TO A WOODEN DECK OVERLOOKING A GRACIOUS BACKYARD
(DOG FENCE BY DECK WILL BE REMOVED)
LAUNDRY ROOM AND HALF BATH OFF KITCHEN
MASTER BEDROOM ( 18 x 16 )
OVERSIZED ROOM TO ACCOMMODATE FURNISHINGS
FULL -BATH OFF MASTER
LARGE WALK-IN CLOSET
BEDROOM 2 ( 16 x 13 )
BEDROOM 3 ( 14 x 13 )
BEDROOM 4 ( 14 x 11 )
LOWER LEVEL PROFESSIONALLY FINISHED WITH QUALITY MATERIALS. BASEMENT HAS
A WALK -OUT DOOR AND SASH WINDOW. IDEAL PLAYROOM, POOLROOM, OFFICE, OR
TEEN RETREAT.
TOWN WATER AND NATURAL GAS, PRIVATE SEPTIC SYSTEM
OVERSIZED TWO CAR ATTACHED GARAGE.
LOT 36
LIE17A,
Job No. e97120
r 11 -
1
1
ry
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Ac Ilk
-
\ * '` r ,.• to ,k ♦ � _ :.-
z .� 1:'�r'�^ � x � �S ` °'} '' s'�-� ��f �o ��, �,�-•t '��' 7�.yK+-x:�d'� ,� "' '...s ,, � � 3 � �.=1c x xi.�! s r �� �.x'er� .rK`wr is x.y • sr ,
.'`i ,e�.�.G»:=`+.e�f �..;�4� F`,�ziox-'s:-T....Y��;^'^�.ca:'.a�"ro':�'.,>�.,,...a...:��:F��A..i�.=.�':��..CSS&.�.:.5:.,�..�'ta`....�.t'+ws`6�'�5.3...L:'�c..:-'?�,s".'�.�,: .. �.r.ir►t?r.;�_::�'r'S F 33:_, ..�.%.- __ __�-
TOWN OF
SYSTEM
DATE:q-2z 1-0
SYSTEM OWNER & ADDRESS
G RECORD
RECEIVED
- 3 2004
TOyEpLTN OF pEPARTMONTER
SYSTEM LOCATION
(example: left front of house)
vi 6� ous
DATE OF PUMPING: QUANTITY PUMPED: GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACIUHLD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
•., ..0 '•��,vri,rla8s
,
. -%BSURME DISPOSAL
DESICdJ CHDCK LIST
LOT l'
PPROV DATE DISAPPROQEp DATE
!rovi deds
Reasons:
itle V F
eg 2.5 The submitted Plan must show as a minimums
`a) the lot to be served-areapdimensians lot
b location and log deep observation hof,abuttera
c location and results. a es -distance to ties
Percolation tests-distanCe to ties
f) ��� calculations &calculations Showing e location and dimensions oP system -including mired leaching area
existing and p osed co g reserve area
g) location � contours •
dfsclaiaer-check wetlands mapping Of sewage disposal system or
(, system OrndisclaimerCe drains within 100+ 01' sewage disposal
(i) location any drainage easements within+
system or diselai�rzr- g board Piles es . of seimge disposal
. (j) k<iom sources of t��ter, .
8'StGm or disclaimer supply within of swage disposal -:
(la location of � proposed well to serve lot -100+ from
1 location of water lines on property -10+ �m leaching leaching facility-
(m)
acility
�(m) location of benchmark :aching facility
n) drivevays
. � ��edisposals
(q) profile ob a used in construction
systsm-elevations of basementp ply
distribution box inlets and outlets distribution Pipes SO tic tank
OtTier elevations ' piping and
-- ). maximum
un
aro d water
(s) Plan must be prepared bevation. in area. set -age -disposal-system -.-
Professional authorized a Professional Engineeror other ;
by law to prepare such plans
' 6 S tic Tanks F
(a) capac t es_ 50% of flow, water table tees
access,p punping s depth of tees,
(b) cleanout
10' from cellar wall or inground swimmia
to) 25sae drains + flrom subsurf g Pool -
/ .
10.2.
Di
stri i
bution boxes
10.4(b) oPe 'eater 0.08
Board o� Health
North Ari,i
APPHOv-ED DATE
1
Inn
OK
SSMC STSM
INS"iM ATTMi CHEPM LIST
LOT
IEXCAVAnON OK k L ___.
F I I ___ -
1. Distance Tot
a. Wetlands
b. Drains
c. Well
2. Water Line Location
3• No PVC Pipe
40 Septic Tank
a. Tess --Length & To Clean Out Covers -
b. Cement Pipe to Tank - On Both Sides of Tank =
5. Distribution BOX
a. Covers & Box - No Cracks
b. All Lines Flo Amg Bqual Amounts
C. No Back Flow
6.- Leach Field or Trench
a. Dimensions
b. Stone Depth
c. Capped Ends
d. Clean Double Washed Stone
7. Leach Pit
as ions
b. S e Depth
c. lash Pads
d. Tess
e. Cement Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
9. Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location Xl.th Regard -to Pere Test
d. Elevations
e: Water Table
s
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner
R C� "-.�_
System Location
7�y
PSR 3 419g�
a Qa
Date of Pumping: q-, 3 ( — vl r? Quantity Pumped: l ,C�--$allons
Cesspool: No H Yes Septic Tank: No U Yes L�-Y
System Pumped by: Fctadort gorev aed License #
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
TOWN OF
SYSTEM PUMPING RECORD _
DATE: C-- (b 'C'3
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: v� QUANTITY PUMPED : " S� 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:
CONTENTS TRANSFERRED TO: "o
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
VQ
re6m .
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
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*
Address /�
Citylrown y\---- State Zip Code
2. System Owner: P'a'ae'��
Name
(if different from location)
own
B. Pumping Record
1. Date of Pumping
State
a 3 — Vm
Telephone Number
Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes 6 2 0 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition ofSystem:�,
tj %
6. Syste Pumped By: r�
f-- --D <Z -a -r
Name Vehicle License Number
Company
7. Location re cpntents were d' sed:
Si-qnatffre ofAlayller Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
ISI
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
- 1 1
SEP 2 2 2008
TOVV'v
r
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 Lor
ti�ob c
Address
City/Town StE
2. System Owner:
Name
Address (if different from location)
Citylrown
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
� ��E --I I
Zip Code
State ^ � <�\ e
Telephone Number T
�� uanti Pum ed:
Date p
Gallons
Cesspool(s) eptic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes DIN -0 --"
IN If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: t'eu-ej
l/
c��`
6. Syste4
7 u ped�By:---
-k- . �(�
Name 2p / Vehicle License Number
Company Il-��`--�'�'�`
7.
its VKNdisposed:
Date
t5fonn4.doc• 06103 System Pumping Record • Page 1 of 1
[BARD
EC�iVE�
_ \j
� Commonwealth of Massachusetts
City/Town of NOV 0 3 1009
a �System Pumping Record OF HEALTH
Form 4
wM
DEP has provided this form for use by local Boards of Health. Other fo s t e
information must be, substantially the same as that provided here. Befo using this form, check th your
local Board of Health tQ determine the form they use. The System Pum ing F gc6rd4,T l � sub itted to
the local Board of Health or -other approving authority.
A. Facility Information HEALTH DEPARTMENT
1. System Location: Left side of house, Right side of house, Left front of hous Right ront of house
Left rear of house, Right rear of house. Left rear of building. Right rear of building.
Address 1-7
City/Town T
2. System Owner:
Name
Address (if different from location)
Cityffown
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
State
Zip Code
State i Code
�� ,,,
Telephone Number
Date Quantity Pumped
Cesspool(s) eptic Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes2-filo
5. Condition of System:
V'"�xt
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
7. Locati here contents were disposed.-
G.L.S.D Lowell Waste Water
Signature of Hauler
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record . Page 1 of 1
Commonwealth of Massachusetts
City/Town of
a System Pumping Record
4fM SV'y`
Form 4 DEC 14 2010
DEP has provided this form for use by local Boards of Healthl O ALF$Fii9 KWI 1596 but the
information must be substantially the same as that providedululu'U51"Tu11b 10 , 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 house, right side of house, Left
rear of house, right rear of house, left side of building, right rear of building, under deck.
" 4 Pc -A, NcA�
City,rrown 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:
a—a—(0
— 2. Quantity Pumped:
Er-ge`ptic Tank
Date
❑ Cesspool(s)
❑ Other (describe):
o�aicup L oae
�
C2�
Telephone Number
4. Effluent Tee Filter present? ❑ Yes D-90----
5. Condition Af Sstem:,
6. System Pumped By:
Neil J. Bateson
Name
Bateson Enterprises Inc.
Company
7. Lo-c�here contents were disposed:
G. L.
N -
fs�
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
V'' L
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1