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HomeMy WebLinkAboutMiscellaneous - 76 EVERGREEN DRIVE 4/30/2018 (2)Commonwealth of Massachusetts City/Town of RECEIVE® System Pumping- Record juga 01.1016 Form 4 5 TOWN OF NORTH ANDOVER y�LRTMENT DEP has provided this form for use -,by local Boards of Health. Other GAMTsH mayDEPAbe 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 Aljgjrear of hou Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address _ City/Town State Zip Code 2. System Owner. Name* t5form4.dof.- 06/03 Address (d different from location) cityfrown ' B. Pumping 1. Date of Pumping F rd _ r — Ps' 3. Type of system: ❑ Date Cesspool(s) State Mp Code ; Telephone Number d r i — 2. Quantity Pumped eptic Tank Gallons } ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes a<o If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition of System: ���;t �h �C � ,('�L✓�� �`�''l�� '�{�v�c �J 1 6.. System Pumped By: Neil. Bateson Name Bateson Enterprises Inc' Company r (�S_ ,S^ contents were disposed: F5821 Vehicle License Number System Pumping Record • Page 1 of 1 44- Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Recordllift `A� ► ZQ�4 Form 4@�i>� �A1� Pyr 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 i ht rear of ho , Left/ right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City1rown l ----CJ State 2. System Owner. Name Address (t different from location) City/Town . B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Trp Code State � /° � Mn _Code Telephone Number r4 4 Data 2. Quantity Pumped: Gallons —< Cesspool(s) peptic Tank ❑Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yep Leo If yes, was it cleaned? ❑ Yes ❑ No; 5. Condition of.Sys J, 9 ' 6. System Pumped By. Neil. Bateson Name Bateson Enterprises Ine Company 7. Location where contents were disposed: Waste F5821 Vehicle License Number Date t5fomn4.doc- 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts a City/Town of W° System Pumping Record Form 4 DEP has provided this form for us&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 R' ht rear of house Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address Cityrrown IQ State Zip Code 2. System Owner: Name Address (if B. Pump! 1. Date of Pumping State—% - Z* Code tiAlf W.3Telephone Number °T�?T 3. Type of system. ❑ IS --D6_13 — 2. Quantity Pumped Q ept� is Tank Date Cesspools) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: I -S -Q Lowell Waste Water t5form4.doc• 06/03 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No. F5821 Vehicle License Number Date System Pumping Recons • Page 1 of 1 Commonwealth of Massachusetts RB�lVC City/Town of System Pumping Record FMAY 2U1 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 &h rear owe, Left /right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town 2. System Owner. Name Address (if different from location) City/Town (-4A,A State Zip Code Stat `,�/' r' 7de Telephone Number B. Pumping Record L -4 -OV -7-i �s 1. Date of Pumping Date 2• Quanti Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent.Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No 5. Condition ,of System: S, 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed:. G.LS. Lowell Waste Water a t5form4.doc• 06/03 F5821 Vehicle License Number Date a-`7 ----/ d System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of W° System Pumping Record tea, SVsy` 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 Pump ngecord,r;ustwbe„subrx�itted to the local Board of Health or other approving authority. R15CEIVED �= A. Facility Information 011 y 1. System Location: � right front of house, left side of Q$se. ri i,Ne 91dWg Left rear of hou �( �v nde-P ” k right r aro ho eft side of building, right rear of b ildlraanunder_•de�tcmPNT 1 �O City/Town 2. System Owner: Name Address (if different from location) r City/Town B. Pumping Record �-3 < < 1. Date %J Pumping - 3. Type of system: ❑ Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Location where contents were disposed: State Zip Code State i� � l 4 j � ode telephone Number — 2. Quantity Pumped: Septic Tank C� Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth. of Massachusetts City/Town of System Pumping Record Form 4 Y DEP has provided this form for use by local Boardsof 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. Syst Location: fomes to the computer, use only the tab key to move your Address cursor - do not use theretum Cityrrown key. 2. System Owner: i State Zip Code TOWN OF SYSTEM DATE: G RECORD SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) �Gd_l � 5 DATE OF PUMPING: QUANTITY PUMPED: O GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES TNATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D�/ Lowell Waste a TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD a DATE: - 0-c>0.- �wr� t'a (example: left front of house) t -6K . 6&. J— DATE OF PUMPING: r, sZQ - b UANTITY PUMPED C. o . GALLONS CESSPOOL: NO YES SEP. C TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: TOWN OF . SYSTEM PUMPING RECORD DATE: `UU� oo��a� SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) ,oust I TV DATE OF PUMPING: _ � r 63 QUANTITY PUMPED: d 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 LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D V Lowell Waste TOWN OF Kj.-AVIJAJff SYSTEM PUMPING RECORD DATE2Q�-. SYSTEM OWNER & ADDRESS JAN - 2 2002 SYSTEM LOCATION (example: left front of house) b O'C-'�c j- kt U'� -( 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 LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: L S b TOWN OF SYSTEM PUMPING RECORDT6 4 DATE: 3 t i`'ry ! ?003 SYSTEM OWNER & ADDRESS \1 SYSTEM LOCATION (example: left front of house) X y d- ko U87c_ DATE OF PUMPING: QUANTITY PUMPED : - GALLONS NO �f YES SEPTIC TANK: NO YES CESSPOOL NATURE OF SERVICE: ROUTINE V EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED �- OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: LJ L - y I., / . .. .. .. _ _...j .. _ _ I. . ' t ' f. t. ,. ' � r � 1 I ' r �- ,�_. � r. ^ A r* ,. = � _ � . , ., _ 4 .. x - .. •,`.. J A 1 u Q rt r1 CD —n �ZI, ro � t ,O% 9 P f� O I rt O E) n G v n 0 3 o a D C v � Lai I _r � W 0 Sv Q 0 _ avv n W ot o c o 0 3 0 m 3 rt � 1 7 7 CL ]+ o A m r LA 1 rt 0 1 0 3 3 0 C 'C i• 3 o y ID j of � v o c a o a � o J -------------- u Q rt r1 CD —n �ZI, ro � t ,O% 9 P f� O I rt O E) Comm nwe Ith of Massachusetts Massachusetts SSysteto I'urnpinu Record System Owner Date of Pumping: 3—C�a Cesspool: No 44� Yes H System Location r/6 �uz!Srew,� Quairtity Pumped: le -)e—1 gallons Septic Tank: No Yes «— System Pumped by: Felredoo Srf&nAlaa License # Contents transferrred to : Greater Lawrence Sanitary District llate: Inspector: APR —7 s Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH August 14, 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X ) or repaired ( ) by _ Robert S 1 ombo INSTALLER at Lat jfh v_rqen Estates, North Andover, MA 01845 SITE L CATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 861 dated 8/30/ 19 96 The issuance of this certificate shall not be construed as. a guarantee that the system will function satisfactorily. �WA ,a ,O.rri`�rr c+e� #83 Lot 6 Evergreen Drive Stephen Henry APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot 6 Evergreen Drive . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall.not exceed 2%. I will install a con- crete septic tank of 1000 in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 200 lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be.surrounded by similar' material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE 4/24/72 Signature of Apflicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 4/24/72 Si,gfiature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE O /%" y bi Signature of I specting Officer Percolation Test 8 Minu6es Soil Sandy Olay Garbage Grinder No BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. z y�X3u I Letab�"vi bed ZXu(/ooa 3a/) �� f 3 AlIng ------� I 3� r^ 1. NAME .. DATE�- 2. ADDRESS B��rQeN br. G La�_JG LOT N0._ / TEL. 3 aq o 3. NO. OF BEDROOMS mm YES NO' 4. GARBAGE GRINDER YES NO r/ 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT. 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. • j" *;. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE NAME OF APPLICANT Stephen Eenry LOCATION Lot #6 Evergreen Drive Address of lot no, BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay Gravel Sandy Clay X PERCOLATION TEST 8 minutes per inch, MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1.000 gallon capacity, LEACH FIELD 200 lineal feet of drain pipe. T rLai= jj William J, Dr coil, Engineer Board of Healt Ci TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: -0I TI (example: left front of house) haa- cF � (�- ��, DATE OF PUMPING: r -8 QUANTITY PUMPED 1 0w CESSPOOL: NO YES SEPTIC TANK: NO NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: GALLONS YES TOVYe0�� ®®� HES EMERGENCY ��. � t; FULL TO COVER BAFFLES IN PLACE------' � LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: (-r -/ , (, , 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 OCT 3 ©2oai System Pumping Record p Form 4 TOWN OF NORTH ANWi,z f HEALTH DEPARTME`N- 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 d i — v— -( ) . — - - r ♦ o—'% City/Town State I Zip Code 2. System Owner: C Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State /� � �jip Cod Telephone Number Date 2 uantity Pumped: Gallons Cesspools)eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 9-196- 5. Condition of System: System Pu ped By: Name Company 7. Location )Qr co tents were di sed: If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number L v -a Y -a7 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of LTOWN ECEIVED a' System Pumping Record AY 2 6 2009 Form 4 --eG• OFNORTH ANDOVER UffAii- DEP has provided this form for use by local Boards of Health. OtheAPbilit th 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: When filling out forms on the computer, use only the tab key to move your. cursor - do not use the return key. 1. System Location: Left front, left rear, left side of house. Right frot, nght:rear)ight si o ouse: Address Citylrown State 2. System Owner: Name Address (if different from location) Citylrown . n Zip Code State Zi Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gaao "s 3. Type of system: 0 Cesspool(s) „'dank Tight Tank _ Other (describe): 4. Effluent Tee Filter present? El Yes wo 5: Con. 'tion of Syst m: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Lowell Waste Water If yes, was it cleaned? Yes [j No ,-4 FUVL v.�(C�� F 5821 Vehicle License Number of 1-146 r Date t5form4.doc• 06103 ' System Pumping Record • Page 1 of 1