HomeMy WebLinkAboutMiscellaneous - 950 JOHNSON STREET 4/30/2018 (2)Im.
r
N . Commonwealth of Massachusetts
,p City/Town of R=GENE®
System Pumping Record MAY 19 2014
Form 4
TOWN OF NGR 1 H ANDOVER
DEP has provided this form for useby local Boards of Health. the"r rm`�s-rnay �f ut 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 Nous% e Right ear of house eft / right side of house, Left /
Right side of building, Left / Right front of buifdirig, Left / Right rear of building, Under deck
Address
City/Town State Trp Code
2. System Owner.
a
Name
Address (if different from location)
City/rown State Zip Code
Telephone Number
t
i
B Pumping Record
1. Date of Pumping
3. Type of system.- ❑
❑ Other (describe):
Date ' (e^ � � �2.uantity Pumped: L. �
Gallons
Cesspool(s) Septic Tank [I -right Tank
4. Effluent Tee Filter present? ❑ Yes
5. Condition of System:
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
No If yes, was It cleaned? ❑ Yes ❑ No:
F5821
Vehicle License Number
t5form4.doe- 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
RECEIVED
City/Town of
System Pumping Record OR ?4,201?
Form 4
M •• TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. OthCUTUFFU5 May De U5CU,u e
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 r r of ho Left / right side of house, Left /
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Addres1q,,5(, ��
City/Town C//
2. System Owner j
Name
Address (if different from location)
Citylrown
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
N,
State
Zip Code
State Zip Code
Telephone Number
Date 2. Quantity Pumped:
�S tic Tan
Cesspool(s) ❑ epk
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes O If yes, was it cleaned? ❑ Yes ❑ No
5. Conditio `y em , J J v-\ 4z.—A—,
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Locati re contents were disposed:
.L'S.'Q _ Lowell Waste Water
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumping Record APR 2 3 2008
g` Form 4
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Oth e
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.
VQ
AA
ISI
1. Systep Location:
;gess ('5D —_ IV, v -�
City/Town State Tp Code
2. System Owner:
Name
Address (if different from location)
CityrF wn
State
Telephone Number
B. Pumping Record L� ( q --Clz�
1. Date of Pumping Date 2. Quantity Pumped
3. Type of system: ❑ Cesspool(s) eptic Tank
❑ Other (describe):
Tip Code
(C)Z)�� -
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes 94�o If yes, was it cleaned? ❑ Yes ❑ No
5. Condit** of System: C
6. System um By; t f
Name Veh a Ucensje Number
Company
7. Location er�cornte posed:
Signature of
Date
Vl
t5form4.doc• 06103 System Pumping Record • Page 1 of 1
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby ake application for a permit for a sewage disposal installation at
' . I will install this system in ac-
cordance wit 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 196 until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of /'e�----o 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 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
Signature of kpflicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Sign,AuWok,Realth Agent
I have inspected the uncovered system indicated above and find everything done
as described. /
DATE A-2
Signature df nspecting OffidikIr
Percolation Test
Garbage Grinder
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
tit so
.l!
4-7
1. NAME�/�;y,� �-,,,�.G.-,�- DATE
2. ADDRESS LOT NO. TEL.
3. NO. OF BEDROOMS DEN YES NO
4. GARBAGE GRINDER YES NO
5. SHOW DIMENSIONS OF HOUSE
, 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
$. 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.
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
NAME OF APPLICAN
LOCATION
SEWAGE DISPOSAL
nATE V19
BUILDING: Dwelling 9 Other
SYSTEM: New X- Repair
GENERAL DESCRIPTION OF LAND
SUBSOIL: Clay gravel Sand
PERCOLATION TEST minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK gallon capacity.
LEACH FIELD lineal feet of drain pipes
R
William J. Dr' coil, Engine.
Board of Healtii
TOWN OF _V /
SYSTEM P
DATE:
SYSTEM OWNER & ADDRESS
Hox-oce-C.)
DATE OF PUMPING.
,ING REC
P"RE—C—E—IVED
MAY 2 5 2005
TOWN )F NORTH C DE ).RTM � TER
SYSTEM LOCATION
(example: teff front of house)
QUANTITY PUMPED:
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 Lowell Waste
GALLONS
,C-\ Commonwealth of Massachusetts
City/Town of Ftat;0
a System Pumping Record MAY � 5 2010
Form 4
\ I
TOWN OF NORT
y
DEP has provided this form for use by local Boards of He th. � ed, but the
information must be substantially the same as that provide e . rm, 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 Loration. Left side of house, Right side of house, Left front of house, Right front of house,
eft rear of hou-sTPight rear of house. Left rear of building. Right rear of building.
Address
Citylrown State Zip Code
2. System Owner: j
Name [
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Date 2. Quantity Pumped: Gallons
Cesspool(s)Septic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes No
5. Condition
\of�S`ys�tem: �&J
- - -1L �_.1/ - - --
6. System Pumped By:
Neil Bateson
7.
If yes, was it cleaned? ❑ Yes ❑ No
F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
of
contents were disposed:
Lowell Waste Water
Dam✓�]�✓
C (�
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1