HomeMy WebLinkAboutMiscellaneous - Exception (518)TOWN OF
SYST:
DATE: -D
SYSTEM OWNER & ADDRF�S
v ik%fw«J\1%-A
PUMPING RECORD
"-7CEIVED
A IPR 1.3 2005
"c 9ORTH ANDOVER I
-f DEPARTMENT I
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: - '1--- QUANTITY PUMPED: iia 0 GALLONS
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
( � I
r FORM U - LOT RELEASE FORM
.1
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 1OUT THIS SECTION
APPLICANT A1ndo✓B✓^orA�+ov� C�aw��c� �nGPHONE18l 93l g�0�
LOCATION: Assessors Map Number PARCEL
SUBDIVISION LOT (S)
STREET 4Z� S��nw�o✓ s%. ST. NUMBER 4271
OFFICIAL USE ONL
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
Z DATE REJECTED
TH
DATE APPROVED
DATE REJECTED
COMMENTS % S -r/'- , fa /l — oi'I--
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT.
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
a
z
VLj�
0
N J
??O::
Y W�
W
S
o
�WSo°►i
°No
ma
USO
J(jQ�
vaa
to
.4
O
o
�.4Z
o