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&�\ Commonwealth of Massachusetts
W City/Town of NORTH ANDOVER RECEIVED
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System Pumping Record
Form 4 MAY 1 1 2015
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other forms may be u§W; NLRWTMENT
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
5. Observed condition of component pumped:
GOOD CONDITION
6. System Pumped By:
JAMES H CURRIER II
Name
X SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD z _fr�-1
Signature of Hauler
Signature of Receiving Facility (or attach facility receipt)
t5form4.doc° 11/12
H79 406
Vehicle License Number
5/5/15
Date
Date
System Pumping Record ° Page 1 of 1
A. Facility Information
Important: When
filling out forms
1. System Location:
on the computer,
use only the tab
371 SHARPNERS POND RD.
key to move your
Address
cursor - do not
NORTH ANDOVER
MA
01845
use the return
key.
City/Town
State
Zip Code
VQ
2. System Owner:
KEVIN EMMETT
Name
Address (if different from location)
City/Town
State
Zip Code
Telephone Number
B. Pumping Record
5//15
1. Date of Pumping 55//
2. Quantity Pumped:
15Il00ns
o
3. Component: ❑ Cesspool(s)
® Septic Tank ❑ Tight Tank
❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑
No If yes, was it cleaned?
❑ Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
6. System Pumped By:
JAMES H CURRIER II
Name
X SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD z _fr�-1
Signature of Hauler
Signature of Receiving Facility (or attach facility receipt)
t5form4.doc° 11/12
H79 406
Vehicle License Number
5/5/15
Date
Date
System Pumping Record ° Page 1 of 1
Commonwealth of Massachusetts
City/Town of NO. ANDOVER
System Pumping Record
Form 4
�M
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
tab
r�
ienm 'V
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
rp rEIVED
A. Facility Information
1. System Location:
371 SHARPNERS POND RD.
MAY - 8 2012
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Address
NO.ANDOVER MA
Citylrown State
2. System Owner:
KEVIN EMMETT
Name
Address (if different from location)
Cityrrown
B. Pumping Record
State
Telephone Number
1. Date of Pumping 4/23/12 2. Quantity Pumped:
Date
3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ® No
5. Condition of System:
6. System Pumped By:
JAMES H. CURRIER
Name
J's SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD
N
Signature of Hauler
Signature of Receiving Facility
01845
Zip Code
Zip Code
1500
Gallons
❑ Grease Trap
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
4/23/12
Date
Date
t5form4.doc• 03106 System Pumping Record • Page 1 of 1
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Commonwealth of Massachusetts
City/Town of NO. ANDOVER
W° System Pumping Record
Form 4
�M
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
rah
retrm
RECEIV -
JUN 0 4 2008
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other formes"s-eised, bid -ire" I
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:
371 SHARPNERS POND RD.
Address
NO. ANDOVER
MA
City/Town State
2. System Owner:
KEVIN EMMETT
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping 5/6/08
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ YesNo
5. Condition of System:
6. System Pumped By:
Benjamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLSD _ /I
State
Telephone Number
2. antity Pumped
Septic Tank
01845
Zip Code
Zip Code
1500
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
5/6/08
Date
t5form4.doc• 06/03 System Pumping Record . Page 1 of 1
4
r
TOWN OF NORTH ANDOVER MORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES a ot`.•a °���
10- y 9
HEALTH DEPARTMENT
400 OSGOOD STREET 4,i. ,r 4
NORTH ANDOVER, MASSACHUSETTS 01845 'SS,GNUS�t
Susan Y. Sawyer, REHS/RS
Public Health Director
April 11, 2005
To all Sharpeners Pond Road Residents:
978.688.9540 — Phone
978.688.9542 — FAX
E-MAIL: healthdept@townofnorthandover.com
WEBSITE: hqp://www.townofiiorthandover.com
Please note that it has come to the attention of the Health Department that many residents are
leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time.
Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the
roadway is a health hazard. Please be mindful of this, as the Health Department will conduct
periodic inspections of the area to determine who is in violation, and fines will be issued if
protocol is not followed.
The Board of Health follows the State Sanitary Code regarding Human Habitation,
105.CMR.410, Section 1:
410.600
(A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight-
fitting covers. Said receptacles and covers shall be of metal or other durable, rodent -proof
material. Rubbish shall be stored in receptacles of metal or other durable, rodent -proof material.
Garbage and rubbish shall be put out for collection no earlier than the day of collection.
(B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a
liner in watertight receptacles with tight -fitting covers as required in 105 CMR 410.600(A),
provided that the plastic bags may be put out for collection except in those places where such
practice is prohibited by local rule or ordinance or except in those cases where the Department of
Public Health determines that such practice constitutes a health problem. For purposes of the
preceding sentence in making its determination the Department shall consider, among other
things, evidence of strewn garbage, torn garbage bags, or evidence of rodents.
410.602
(A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for
maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish
or other refuse. The owner of such parcel of land shall correct any condition caused by or on
such parcel or its appurtenance which affects the health or safety, and well-being of the
occupants of any dwelling or of the general public.
(D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way
owned or used in common with other dwellings or which the owner or occupants under his
control have the right to use or are in fact using shall be responsible for maintaining in a clean
and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the
passageway or right-of-way which abuts his property and which he or the occupants under his
control have the right to use, or are in fact using, or which he owns.
V* Residents should know the following:
The Town has a mandatory paper and cardboard recycling ordinance that requires
residents to separate these items from their household trash. Paper and cardboard are
collected every other week on the same day as the household's normal trash. Residents
can call the DPW at 978.685.0950 to get their recycling schedule.
Residents are responsible for picking up loose trash left at the curb after collection.
Banned Items and Recycling Requirements:
Please refer to the DPW website for a complete list of all the recycling requirements:
http://www.northandoverrecycles.com.
Please contact the Health Department if you have any additional questions. Thank you.
Zan
}Sawyer, REHS/RS
Public Health Director
File
CURLIER
SEPTIC & DRAIN SERVICE
107 FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772
e
FORM 4 - SYSTEM PUMPING RECORD
0
COMMONWEALTH OF MASSACHUSETTS
C� U ' r , MASSACHUSETTS
SYSTEM PUMPING RECORD
to 'r
3 ? f S ��cpnec� pOxd
m
SYSTEM LOCATION: l� 0
C k \,G �- d
DATE OF PUMPING: 3 - 07 �/ v 1 %
QUANTITY PUMPED:
/5-C>O
GALLONS
CESSPOOL: NOYES
0 F7
SEPTIC TANK:
NO F7
YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO:
DATE: 3 - 2 INSPECTOR:
RECEIVED
� Commonwealth of Massachusetts
W City/Town of NO. ANDOVER JUN - 6 2OD�
System Pumping Record TOWN OF NORTH ANDOVI
G" M 5y0 -W
Form 4 HEALTH DEPART T� T
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
iedm /
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:
371 SHARPNERS POND RD.
Address
NO.ANDOVER
City/Town
2. System Owner:
KEVIN EMMETT
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
5/22/06
Date
Cesspool(s)
4. Effluent Tee Filter present? ❑ Yes X No
5. Condition of System:
6. System Pumped By:
Benjamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLSD
MA
State
01845
Zip Code
State Zip Code
Telephone Number
2. Quantity Pumped: Gallons
❑ Tight Tank
1500
E Septic Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
5/22/06
Date
t5form4.doc- 06/03 System Pumping Record - Page 1 of 1