47 Title 5 Pumping Record 2010, Water analysis 2003, Septic Construction Permit 2003 No. / ✓
COMMONWEALTIIOF ASSACIIUS£TTS
A
Board of Health
DISPOSAL SYST
Permission is hereby granted t ; Construct( epair( ) Upgrade ) Abandon( ) an individual sewage disposal system
at
it � tn. A.A.
£�1 CONSTRU
/EON PERMIT
•
FEE 75
f NO' //I kf/i 5
Disposal System Construction Permit No. 3-03 dated
as described in the application for
Provided: Construction shall be completed within three years of the date of this All local conditions ust be met.
win uss Rev. aM SuIk!�co.e�m�.MA Date V/roj Board of Health ,� -t_ z
APR - 3 2003
HO W
I Sample 6 10499 I
LABORATORIES OF NEW ENGLAND, INC.
750 North Pleasant Street
Amherst,MA 01002
,Phone: (413)549-8260 Fax: (413)549-1850
MA Lab License: M-00851
WATER ANALYSIS REPORT
Analyzed For: Wright Builders
Address: 48 Bates Sifter
Nonhamplon, MA 01060
Telephone:
Sample Location: North Farms Road
Sampled By: HWD
Date Sampled: 328/03
Date Received: 3/28/03
PARAMETER
RE,OLTS
LIMITS
COMMENTS
Recommendations: Solt :, lose f MA DEP IaSemr
sk.
This sample meets acceptable standards of potability for the parameters tested,except for those parameters
marked with an asterisk(•).
Analyst'. BO,]B
Checked By: I
Laboratory.
Date: 42/03
Total Caliform
Bacteria
0 Oaaaia/1Wad
0 Colonial IOOM
OK
l.
pH
6.63211 Irma
6.54.6 pH U'n
OK
Manganese
0.022 mgt
o05 me
OK
Hardness
35 mat
Na Randal
eo SOFT >KO HARD
COnduCtiVity
0.13 m5M1m
No3vdrtd
No Jaded
Chloride
18.8 myi
250 me
OK
Iron
0.10 mtn
oimyl
OK
Sodium
17 my1
28 me
OK
Nitrate
0.2 mail
is tag/1
OK
Nitrite
0.003 mur,
i mst
OK
Color
•
17 wcoColor Was
b mca cum vow
a
Turbidity
5.36 Kt;
5 Nn-'
Recommendations: Solt :, lose f MA DEP IaSemr
sk.
This sample meets acceptable standards of potability for the parameters tested,except for those parameters
marked with an asterisk(•).
Analyst'. BO,]B
Checked By: I
Laboratory.
Date: 42/03
,,t'tTI/ L-11/12/ U yam ,
Commonweal ��jj of7V]assachusetts .
City/Town of ) frmintieli
System Pumping Record
Form 4
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.
A. Facility Information
Important:
When filling out 1- System Location:
forms on the
computer,use
only the tab key Address
to move your
cursor-do not
use the return
key._ 2. S stem Owner,
l »IZ■ 3Rkti) /CEO
4n) dU . FR-!Dns
Clty/rown
State
Zip Code
Address(if different from location)
Ciy/rown
krnir
^te /„ '1 3(1 Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 9/O 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank 7 Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yep] No If yes,was it cleanedn es ❑ No
5. Conditio n of System:
6. Sy3(enj. ufgped By.
Nam
Corn any
7. L C ion where contents were disposed:
Vehicle License Number
Signature of Hauler Date
Signature of Receiving Facility Date
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