HomeMy WebLinkAboutMiscellaneous - 95 LIBERTY STREET 4/30/2018 (3)�,t
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Commonwealth of Massachusett
City/Town of
E D
System Pumping Record Jum •, C Z013'
Form 4
TOWN OF NORTh.PI VER
DEP has provided this form for use: by local Boards of ' er ' _. a e 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/ Rightear of house eft / right side of house, Left /
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address q p
r
Citylrown State Zip Code
2. System Owner.
Name
Address (if different from location)
City/rown
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
State Zi Co
Telephone Number
Date 2. Quantity Pumped
Cesspools) Septic Tank
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes lam' No If yes, was it cleaned? ❑ Yes ❑ No.
5. Condition of stem:
6. System Pumped By:
Neil Bateson F5821
Name, Vehicle License Number
Bateson Enterprises Inc
Company
7. Location ere contents were disposed:
L S Lowell Waste Wi
—1 _
Co -L�- (�
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth
rg.
of Massachusetts
OEQE Filo No. 242-322
(To be provided by DEQE)
Cily/Town North Andover
ADPIiCant Republic Development
-t Y Lot 6'Liberty Street
Certificate of Compliance
Massachusetts Wetlands Protection Act, G.L. c, 131, §40 &
under the Town of North Andover )3y -law, Chapter 3 Section 3.5 A&B
From
North Andover Conservation Commission'Issuing Authority
To Republic Development Corp., Village Road — Suit 100 Danvers, MA
(Name) V
(Address) 01923
Date of issuance July 22, .1987
Republic Developmen
This Certificate Is Issued for work regulated by an Order of Conditions' issued to
dated Dec. 23, 198;nd issued by the NACC
It is hereby certified that the work regulated by the above -referenced Order of Conditions has
been satisfactorily completed.
2. ❑ It Is hereby.cedified that only the following portions of the work regulated by the above -refer-
enced Order of Conditions have been satisfactorily completed: (I1.tho Certificate of Compllancc
does not Include the entire project, specify what portions are included.)
3. El It is hereby certified that the work regulated by the above -referenced Order of Conditions was
never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No futL
work subject to regulation under the Act may be commenced without filing a new Notice of Intel
and receiving a new Order of Conditions.
J
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