Loading...
HomeMy WebLinkAboutMiscellaneous - 84 BRUIN HILL ROAD 4/30/2018 (2)12 u co Co 6 12 u m ' MAP # LOT ` ` PARCEL # STREET ON_AP.PQO#AL HAS PLAN REVIEW FEE BEEN PAID? PLAN APPROVAL: DATE APP. 8Y DESIGNER: PLAN DA[E � CONDITIONS ' WATER SUPPLY WELL _ WELL PERMIT DRILLER__ WELL TESTS: CHEMICAL�DAlE APPKUVED ACTE DA|E PPMUVED PHUVEDACTE�� II DAlE A __._ ...... _..... __ COMMENTS: ' \ FORM U APPROVAL: APPROVAL TO ISL3LIEZ YES --' DATE ISSUED CONDITIONS: v,�D __~_-- -__------_- FINAL APPROVAL: ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL S IIO OTHER YES NU ANY VARIANCE NEEDED YES FINAL BOARD OF HEALTH APPROVAL: DA|E: BY: A V11 �ISSUANCE OF DWC PERMIT DWC, PERMIT NO.. .,!.ir,,,,BEGIN INSPECTION C=---Y-ES NO: NEEDED: EXCAVATION. INSPECTION: Em (---n W� y YES YES NO INSTALLER:7-/--�13 A 13Y P A SSE D CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: B Y B FINAL. GRADING APPROVAL: DATE 'o Azz y I DATE: BY AA ',`,i F I NAL CONSTRUCTION APPROVAL: "Y1 S -THE INSTALLER LICENSED? TYPE OF CONSTRUCTION: NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW CONDITIONS OF APPROVAL (FROM FORM U) �ISSUANCE OF DWC PERMIT DWC, PERMIT NO.. .,!.ir,,,,BEGIN INSPECTION C=---Y-ES NO: NEEDED: EXCAVATION. INSPECTION: Em (---n W� y YES YES NO INSTALLER:7-/--�13 A 13Y P A SSE D CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: B Y B FINAL. GRADING APPROVAL: DATE 'o Azz y I DATE: BY AA ',`,i F I NAL CONSTRUCTION APPROVAL: "Y1 -C C10 0 0 Cl) rt (D LO /Zi u (D CD CL m F -t* (D 0 -h -n El (D (D 0 c 0 Cl) rt (D LO /Zi u (D CD CL m F -t* (D 0 -h -n El Y 1VbV\0:b j)0C)I FORM - U - LOT RELEASE FORM 0 1NSTRUCTIONS: This form is used to venify that all -necessary approval/ permits from Boards and Departments having juni sdiction have been obtained. This does not relieve the applicant and or landowner from compliancewith any applicable requirements. Ock APPLICANT G e0 fZ:t X C> - 4 '(PHONE 617 69-4 17,475 (W) i - A ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOTNUMBER STREET Xq3jv,jj, NUMBER T4 bif kii h loomospoonnounno .............. All Room OFFICIAL USE ONLY loodoonownwoom mono ......................................................... a RECONWENDATIONS OF TOWN AGENTS E.n 0 0 n N 0 n 0 N a a 0 0 a 0 0 a a 0 0 E E a E a o N a N E E M a 0 0 y00- DATEAPPROVED 77 C SERVATION ADNIINIS OR DATE REJECTED (16 TOWN PLANNER CONEVIENTS FOOD INSPECTOR - BEALTH SEP'ng,KAEC� - FtAIIT�--__ ,;r_1 / DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COUNIENTS PUBLIC WORKS - SEWER WATER CONNECDONS e -C 2 - DRIVEWAY PERMFr P FIRE DEPARTNENT CONMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED -0 4 , J,01"9- Y CZe7l,-r 741 7W,— —1;'4 -- IAIS&XaC IWIO 7,VJF .4%4,Or rAW;r le 4Vk-.41;ry 0,V 7-1W;-17-,aO49--f e4w,-,:neW _-aVIVd 4-A-eFAt,4rAWS e'V- Zl+'Z�y I_r IrjoeWYCAw C--APrl,-rY )PA44,7- 7;V" 4awlr4zl" IS 1-4/or 4iV-4rZ-P IAI -TI-W-14welv t 4�, -eel avoe /74 0 r 1='Z 4AI AIV TO 39vi SP�TSLP—OOS c3Z:60 LGGT/90/'�O 1,71 N /,m oo oo 00 (r) kyj I-) m im m I, m — " Ln C, . . . . . . . . . . . . . . If, ly) :yj o 1. r) 17r) co yj Im 04 4:1 A) '43 '-4j 4:1 IT, — �:j Lli . . . . . . . . . . . . 4 . . . . . . . . . . . . . . LX . . . . . . . . . . . . . . I'll 0 D - -4) IZI o" 4 z LK 1"�l w W ID Fri C 4-1 at 'j, -n- o ,, — — n - 'It C C -- — 4� C D CL df tb C) 4-1 C CIL Z IN IZI OL L 4`1 LL -n_ w Q) 4-1 x 41 41 c Sc ML 4j cl Cj Ll oil C 0 Z _j LL F- Ci n M W Commonweafth of Massachusetts ExecLAve Office of Environmental Affairs Department of Environmental Protectkon, 1i k1-10 VAIllam P. Weld Argeo Paul Celluccl U. CK"Mor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFIFATIPN Property Addresa:e �jcx-*j�- 6&A&V-rAddress of Owner - Date of Inspection: (It different) Name of Inspector- 06A11- 4e,�C� Compamy Name, Address and Telephone tarnber. BATESON ENTERPRISES, INC. E�cavatlng - Water & Sewer Unes - Septle Syltemo & Pumping SmIce I I I Argilla Road 6 Andover, Mass. 0 18 10 0\ 0, h Trudy Come Socrolary Dev Id 19. Struhs CornmWloner TEL- (5091475-14-7-4 FAX: J508) 475-5-131 CERTIFICATION STATEMENT I certify that'l have pei-sonaffly inspected the sewage disposal system at this address and that the information reported below 6 true, accurate and complete as of the time of inspection. The inspection was performed based 6 my training and experience in the' proper hinction and tn.-dntenance of on-sit�. ;m"N%-�agei pogal eyaterrm The system: Passes Conditionally Passes Nee4s Further Evaluation By the Local Approving Authority FADS Inspector's Signature! e�) f Date: Z:> —7/ The Systern Inspector s A1.1 su t a co f this inspection report to the Approving Authority within thirty (30) days of completing this I jD, inspection. If the system is it shared system or has a design flow of 16,000 gpd or greater, the impictor and the system owner shall submit the report to the appropriate regional office of the Department of EnvironmonW Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable And tho approving authority. INSPECTION SUMMARY: Check A, B, C; or D: A] SYS PASSES - I have not found any information which indicates that the system violates any of the failure criteria an defined in 310 CMR 15,303. Any failure criteria not evaluated a" indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in &H Insfiinca. if "not determined", explain why.not) The septic tank is metal. cracked. structurally unsound, shows substantial Irliffirdtion or ex0ration, or taAk failure is imminent. The system will pass inspection if the existing septid tAA lb r*placed with a ronforming septic tank is ��proved by the Board of Health. (revised 11/03/95) One VAntir Street 0 Boston, Massachusetts 02108 6 FAX (07) SW049 Telephone (617) 292-SWO Pnnted on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �JOCV'kf\' "IVD14— Ow-ner. v��(A�bu Date of Inspection: 91-7 Rl SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high aWic water level observed in the distribution box is due to broken or obstructed pipp(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): broken pipew are replaced obstruction is removed distribution box is levefled or replaced AIL� The PyRtem rvquired pumping more than four times a year due to broken or obstructed pipe(s). The system wW inspootion it $Willi hpor4oiij t4t ilio n"W'4 0r 'tj4j4jfhj! broken pipeoq) are replaced obstruction Is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system in failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HFALTH DETERMINES THAT THE SYSTEM 19 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THIC ENviRONMIMNIN — Cesspool or privy Is within .50 feet of a surffice water — Cesspool or privy is within 50 feet of a bordering vegetated wetiand or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM 19 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETYAND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributM to a surface water supply. — The system has a septic tank and soi] Absorption system and is within 6 Zone I of a public water supply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water iupply weft. — The system has a septic tank and soil absorption system and in less tham 100 feet but 60 feet or more &am a private water supply weU, urdess a weH water analysis for coliform bacteria and volatile organic compounds indicatih that the weh is free from poUution from that faci1ity and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) OTHER (revised 11/03/95) ly SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner Date of Inspection: D) SYSTEM FAILS - I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage. into facility or systern component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. — Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. — Required pumping more than 4 times in the last year NOT dueto clogged or obstructed pipe(s). Number of tirnes pumped — Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. — 'Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the envionment because one or more of the following conditions exist: — the system is within 400 feet of a surface drinking water supply — the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone H of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addrear. Owner. Date of Irmpection: SCCA -7 Check if the following have been done: /P.ping information was requested of the owner, occupant, and Board of Health. _LXe1_1 It the sysum 401upe"Onta hAvo bo@n V"_ pod for at Ig!AAt two woke Md the #'"tern )w- b"n tft-sivitia "OYMAI flow MAN during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. built plans have been obtained and examined. Note if they are not available with NIA. _L,A'e I#cffity or dwelling was inspected for signs of sewage back-up. =4be m does not receive non -sanitary or industrial waste flow e2#e-*a9 inspected for signs of breakout. system components, excluding the Soil Absorption System, have been located on the site. ��e aseptic tank man -holes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or _L2tees, terial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. e',7ize and location of the Soil Absorption System on t I he site has been determined based on existing information or Zapp ted by non -intrusive methods. e fa�cihty owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub - Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner. Date of Inspection: FLOW CONDITIONS Esirm AMMIN A AA." Design flow: L4 1q.L)-. gallons Number of bedrooms: 4 —qeQ,: Number of current Garbage grinder (yes or no): Laundry connected to system (yes or no): Yes Seasonal use (yes or no) �j U r Water meter readings, if available: at4-7 LA& date of occupancy: .4/36-S-ckn� S z- D;6 p4A &�aj ,VA / RC, Z -g'4 9 Q Q ­ck /CA COMMERCIAL/INDUSTRIAU Type of establishment: Design flow:_____gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non -sanitary waste discharged to the Title 6 system: (yes or no)_ Water meter readings, iY available: Last date of oecupancy:_ OTHEIL (Describe) Last date of occupancy:_ GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of 1'=,pection: (yes or no)4es If yes, volume pumped: .110t"� Reason for pumping: o�j 44w - TYPE OF SYSTEM Septic taWdistribution box/sou absorption system Singie cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: �Ij Sewage odors detected when arriving at the site: (yes or no) " C.) (revised 11/03/95) 5 1. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:. 0�'4 �jo'�JJ& Date of Inspection: 91-7 SEPTIC TANK (locate on site plan) Depth below grade: Material of construction: _�t4nrete —metal _FRP —other(explain) Dimensions: Now& Sludge depth: NAaaeo Oom top of foludoe to bottom of outlet tee or baffle:, C Scum thickness: 4V 11 Distance from top of scam to top of outlet tee or baffle: 9 1 V Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumpiR,)conditiQn of ildet and tl t tees or.1 baffles, Pept liquid leyel relation to putlet inve ru integrity, U evidence of le4kagq, etc.) !n" &OT Ar :0��.A_4 C) 1 10 -A-) lc(e JER . �j =&:�* GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: —concrete —metal _FRP _other(exphdn) Dimensions: Scum thicimess: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addreaxey Owner. FA �' A - Date of Inspection: TIGHT OR HOLDING TANK Vj0fV (locate on site plan) Depth below grade:_ Material of construction: —concrete —metal —FRP —other(explain) Dimensions: Capacity: vallons Design flow: Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX - (locate on site plan) Depth of liqt6d level above outlet invert: 0 PUMP CRAMBER:- (locate on site plan) Pumps in working order:(yeg or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addrew 4 �b �A Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS)! (locate on mite plan, if possible; excavation not required, but may be approximated by non-intruaive methods) If not determined to be present, explain: Typo: leaching pits, number:_ leaching chambers, number: leaching galleries, number: leaching trenches, number,length,- leaching fields, number, dimensions: overflow cesspool, number: 't�o"\.50 CESSPOOLS: tJ\OV\e (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scurn layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (empool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic faflure, level of ponding, condition of vegetation, etc.) PRtVY: V\Me (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) �jProperty Addres&- eq BcUA f\ F" Owner. "Ate (st Inapepoolu S — SEXMH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 0" L4 1c, A- 10 DEPTH TO GROUNDWATER Depth to groundwater: feet method of determination or approximation: (revised 11/03/95) 9 13 LA W%\Q, System Owtier G,, k System Location Contents tionsreirred to i Date. - v 1� Gfeater 6wrence Sani ry-District cr to rn CL r" S.. :; � CL > cm W I N�v Z -n rn M OR t7z S C) rTli V) V) 0 0 z -7 rT,l rT,l > < r7l (/)S. CLI Z CL CCU cr :j4 io - 10 T m :0 0 co =r cl 7! (a m 0 fn m =r rl M T 0 c M O:D 1 L C (m w 0 it z , p � m > T z > z 1�2 .. > oq L, IT IT IT -n rn M OR t7z S C) rTli V) V) 0 0 z -7 rT,l rT,l > < r7l (/)S. CLI Z CL CCU cr :j4 io - 10 T m :0 0 co =r cl 7! (a m 0 fn m =r rl M T 0 c M O:D 1 L C (m w 0 it z , p � m > T z > z 1�2 .. > oq L, m z -0 m al W CA 0 No V -INQ N P=i 0 44 0 wl zer 3 -gleolxl House Tank IN Tank OUT D -box IN D -box OUT Trench Inverts Line 1 Line 2 Line 3 Line 4 AS -BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations /W/ V, A / 163,71 7/ 163,37 /,� -3 , 2, Bottom of Exc. //0 Iq . I - Stone OK? L---- D -box checked? As -Built Elevation CIO 163,71 /63­1� 163- _qoO - 16 3, 3 'el 16R, 0-3 Pipes cemented? 4-- FORM U - LOT 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 or requirements. *****************************APPLICANT FILLS OUT THIS APPLICANT ISU C �CPHCNE 9 2 70 � 7425 coj� LOCATION: Assess&s Map Number 10q �PARCEL '21610zi- A 0001 E7 '066o_d SUBDIVISION LOT (S) STREET Z-11 Byl/io. A Rd - T. NUMSER_g_Z-- USE ONLY*********** RECOMM NDATiONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED. DATE REJECTED— lo COMMENTS lic� �V, TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDiNG !NSPECTCR DATE Reviced 9\9"jm -A `7 Town of North Andover, Massachusetts Form No. 3 ,IORT#f BOARD OF HEALTH + 19 CHUS DISPOSAL WORKS CONSTRUCTION PERMIT Applicant 7� —ry.- MA J --AJ VL-� NAME Site Location Permission is hereby granted to, Constructl�-41 or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No.- -2—ZLi—&A r- . , �,j CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. M LOT -PLOTAPLAN OF Scole 0/2� DANA PERKINS, CIVIL ENGINEERS 6nd SURVEYORS READING - TW�-560?-�MASS. i'-C-rc�uy cerfiiy that the buOding on Lot 3 ated a - .is locc pproxim, ately as sbown hereon and that i.1 conforms 0 Iv Of 4"! Lii of Dana e X m J, E By yw No. 30747 - Is L t V 79. iA To V - ---------- May 18, 1992 NORSE ENVIRONMENTAL SERVICES, INC. 3 Pondview Place TyngSboro, mass. 01879 TEL. 649-9932 Michael Rosati North Andover Board of Health Main Street North Andover, Ma. RE: Lots 3,4,5,6 Bruin Hill Road Dear Mr. Rosati; Enclosed are the revised plans for lots 3,4,5 and 6 Bruin Hill Road subdivision. The following changes have been made: Lot 3 Denotation for Schedule 40 PVC pipe Top of foundation elevation Lot 4 Denotation for Schedule 40 PVC pipe Top of foundation and cellar floor correction Fill easement from lot 5 Lot 5 Denotation for Schedule 40 PVC pipe Fill easement on lot 4 Top of foundation Lot 6 Denotation for Schedule 40 PVC pipe Top of foundation Revised system to be 501 from the drain, by eliminating the third trench and increasing the sidewall area of trenches one and two. Unfortunately the invert elevation of the drain line is below the system. Also, the wetlands in the rear of the lot further limits the area we can use. Thank you very much for calling these omissions to our attention. e yo, *ter r sen Norse Environmental services, Inc, Commonwealth of Massachusetts Massachusetts System Pumping ecord yst�", —O%V,1�1' 01-a��u �� 2A - Date of Pumping: Cesspool: No Yes System Location V'\ TOVIN 0. "PRT, -I r.oOVER/ 0 F T MAR 1 1 1997 Quahtity Pumped: 45e�� gallong Septic Tank: No Yes Sy (em Pumped by: Ferredeff License s Contentstransrerrredto: Greater Lawrence Sanitary District Datle: Inspector: .1 N 111� ID UT OW bo Commonwealth of Massachusetts Massachusetts System Pumping Record $y0tom Owner System Location )31�V)N MILC A /,jDo vm Date of Pumping: 0 -q6 uantity Pu'mped: 0 gallons CzupDDj: No Yes 5gzk-T=k: No F1 Yes Y System Pumped by: 64&4" SwAnAu-w License # Contents transferrred to Greater Lawrence Sanitary District Date: Inspector: 'FOWN OF ORIN ANDO) L) A I F, SYSTEM P MplNQ RECO SYSTEM o"E.-A & AVORESS Ack s- V116111-oIJ9 RECEIVED NOV - 3 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 0 T a I tM LOCATION P—,L -7 7 .//L/ DATE OF PUMPING: QUANTITY PUMPED: CLSSPOOL: NO_ -k YES— � S00c I'ank: NO_ YEST NA rUKE OF SERVICE: Kou'rINE...­)�... EMERGENCY 013SERVATIONS: GOOD CONDITION FULL'M covEjR HEAVY ORMASE BAFFLES IN PLACL ROOTS LEACKRELD RUNBACK WeSSIVE SOLIDS FLOODED SOLI'D CAkRy0V`ERl"..­ OTHER EXPLAIN SY&LOM P'Wnpcd by 1-77al .. .... ..... .... CUN I hN FS I"KANSYbRALD I'() I 'A *1