The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 850 JOHNSON STREET 4/30/2018 (2)l / rr $' Commonwealth of Massachusetts R E C E lugCity/Town of 0 C T 0 8 2013 System Pumping Record Form 4 BOARD 01 HEALTH 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�e� Ri rear of ho , Left / right side of house, Left / Right side of building, Left / Right front of bd1Ml ing, Left / Rlg rear of building, Under deck City/Town 2. System Owner. Name Address (if different from location) Citylrown B. Pumping Record 1. Date of Pumping 3. Type of system. ❑ State` tiAR 0 11U Zip Code State Zi Code 3�1� Telephone Number'., i Date 2. Quantity Pumped: Gallons i. Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 0 No If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition f stem: A o,��.�.c�,(. 1� ••vim � v� � 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Lowell Waste Water F5821 Vehicle License Number 9 —CT— L_3 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RhGt:lvru City/Town of - System Pumping Record SSP � 5 cu IZ 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, Le _ t iahof h sa, Left /right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City/rown State 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Zip Code State Zip Code Telephone Number Date �eptic ty Pumped: Cesspool(s) Tank "-7S2�) Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 2 No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition ofst o `qA� 4l ,� - JV .X , - / e ,�,�-- 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locati re contents were disposed: G.L S. Lowell Waste Water t5form4.doc• 06/03 F5821 Vehicle License Number <5'-<�3v .- IQ Date System Pumping Recons • Page 1 of 1 Commonwealth of Massachusetts F City/Town of�q a W° System Pumping Record Form 4 ria N i l DEP has provided this form for use by local Boards of Health. Other d,,g��` information must be substantially the same as that provided here. B 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; rightar of hous left side of building, right rear of building, under deck. Cityrrown State Zip Code 2. System Owner: 4P�4CD--Z(:� Name Address (if different from location) City/Town Stat�C� �M Code Telephone Number B. Pumping Record 1. Date of Pumping Date Z. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes D-IVo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Location where contents were disposed: L.S.D. ow Signatur f ul r t5form4.doc• 06/03 F5821 Vehicle License Number Date 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. Commonwealth of Massachusetts ��® City/Town of System Pumping Record APR 2 4 2006 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of He a System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Address A/' Cityfrown State 2. System Owner. Name Address !if different from 1nrnfinnI Zip Code City/Town State Zip Cade Telephone Number B. Pumping .Record 1. .Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) eptic Tank- ❑ Other (describe): Gallons ❑ Tight.Tank 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? E] Yes ❑ No 5. Condition Rf System: 6. System a ApfdB,1`1 Name Company .7. Location wh re c nten� Cts were is ed: ` c Signature of Ha le http://www.mass.gPv/dep/water/ap rov Is/t5fo t5form4.doc• 06/03 F�� Vehicle License Number System Pumping Record • Page 1 of 1 1�~.. .. : < { . r t f , • Arur Kent 66-6 Johnson St. 1 r 7114A a- APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPART DENT --NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Johnson St. . I will install this system in accordance with all the lav -is of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Furtherp I will construct the house sewer of ben and spigot pipe] the minimum diameter being 4 inchest and will maintain a minimum grade of 1,% until 10 feet preceding the septic tank# where the grade shall not exceed 2%. I will install a concrete septic tank of 750 sal. 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 open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches, the bottom of which will provide a minimum of 125 lineal (AM=) 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/S" to 1/4n (dia.) will be placed over the course vel or stone. The disposal field win be ,installed at a grade of 4 to 6 inches 100 feet. No single the line will exceed 100 feet in length and in any case, two lines of tile wiU 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 in— stallation 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 officer, as provided belows and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. t DATE t �— Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts, DATE Si nature of Health Agent I have inspected the uncovered system indicated above and find everything dans as described• DATE CLL _" � _.•_..._�...........�.1 Signature of Tjopecting Officer Pereolation Test 2 min• Garbage Grinder _-_- L' - i July 12, 1958 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Johnson Street building site of Mr. Arthur Kent. The subsoil in the area was of a sandy clay content and a 2 -minute percolation test was conducted. The land in general is high. It is recommended that a 750 gallon concrete septic tank be installed together with 125 lineal feet of drain pipe. Very truly yours, VWijlliaLmJ-.'D scoll I �-40' 21 HOARD OF HEALTH TOWN OF NORTH ANDOVER* MASS. fi 3� �...�.._.._._ 16 1 t -a t4l ,. 3?' ,.._..,_. _... ►a 'jS'�?C�4c�apr,t�lA�tN I UTA 10 NANE -. � �?TK .. . F ,1rE tY �-' .... .... DATE . . ....... . 2. ADDRESS. �° {� Sutd �? ... . .LOT NO. ..TEL. . . �. . . 3. N0., OF BEDROOIS . `;Z.. DEN YES NO.. l�. GARBAGE GRINDER MESS « . N0. 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LIDS 7, SHOW DDENSIONS 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 CF MOOKS O STREA?S, DITCHES t LWGE OUTCROP, ETC. ll. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD DE READ CAREFULLY. 1C'X Commonwealth of Massact City/Town of System Pumping Record ,M s. Form 4 DEP has provided this form for use by local information must be, substantially the same local Board of Health tQ determine the form 1 the local Board of Health opother approving A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, of hou , Right rear of house. Left rear of building. Right rear of building. A Address Citylrown y State 2. System Owner: Name Aooress (rt Werent from location) Cityrrown B. Pumping Record 7 � 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) AILAI_4�� Zip Code State Zip Code Telephone Number — 2. Quantity Pumped eptic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 0 ' Gallons ❑ Tight Tank our 1 to If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System- -�'( ? %07 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loca- re contents were disposed: L.S.D Lowell to Wa er Signature o er Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1