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HomeMy WebLinkAboutMiscellaneous - 112 FOSTER STREET 4/30/2018 (2) N Commonwealth of Massachusetts City/Town of 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. A. Facility Information 1. System Location: Left/Right front of house, Left/ I h rear of hous. Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address CWrown sem/ state -�t� Zip Code 2. System Owner. Name Address(if different from location) State Zi Code Telephone Number B. Pumping"Radord - wv� 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank El Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Ye. o If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition of Sys CC 6. System Pumped By: S. Nell Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Location where contents were disposed: S. Lowell Waste Water Sign Haule Date t5form4.doo-06/03 System Pumping Record•Page 1 of 1 T Commonwealth of Massachusetts ` • North Andover BOARD OF HEALTH y ` 1600 OSGOOD STREET �>nati +v BUILDING 20; SUITE 2-36;South NORTH ANDOVER,MA 01845 DATE PRINTED: 03/07/2012 ESTABLISHMENT NAME: Twin Oaks Farm Twin Oaks Farm 112 Foster Street c/o: Steve Young NORTH ANDOVER MA 01845 File Number:BHF-2004-000156 LOCATED AT: 122 FOSTER STREET , MA Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes Animal Permit BHP-2012-0522 Mar 1,2012 Feb 28,2013 $35.00 50 Cattle;50 Sheep;50 Chickens/ Steven Young;978.683.0753 or 617.710.9194 Total Fees: $35.00 PERMIT EXPIRES February 28,2013 BOARD OF HEALTH 1 ll..L Page 1 f 3 k ,.T 601 Of MO e 't F Towh of North Andover .: HEALTH DEPARTMENT ,SSACMUStt CHECK#: _� � DAT is LOCATION!/ c�C ` H/O NAME: CONTRACTOR NAME: Typg.,6f Permit or License:(Check box) Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ I ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: s ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer t NORTti TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT �''sAC 1600 OSGOOD STREET; Building 20; Suite 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director healthdept?_townofnorthandover.com Animal Permit Form www•townofnorthandover.com The undersigned hereby applies for a permit to "KEEP CERTAIN ANIMALS AND BIRDS" within the Town of North Andover, in accordance with Chapter III, Section 23, 131 and 143 of the General Laws, and subject to the rules and regulations of the local Board of Health and Zoning Bylaws. �1 ADDRESSILOCATIONOFANIMALS: Q,2 �'�Pr' /��c�Q✓ ! �p�4�� OWNER'S NAME &T/f K1 OWNER'S ADDRESS/LOCATION IF DIFFERENT: //o? l 6s der S-}-, X/ 4,Jv vc'FF rvlA,• Dealer: Yes No X TOTAL ACREAGE: ?o Adult Young(number of) 1.Cattle(Adult=2 years&over) �U Dairy Beef 7.Poultry:Chickens Turkeys Steers/Oxen 8.Rabbits: 2.Goats(Adult= 1 year&over) 3. Sheep(Adult= 1 year&over) 9.Other: 4. Swine: Breeders - Feeders EC 5.Llamas/Alpacas 1A (� ` 6.Equines: Horses/Ponies TOWN OF NORTM ANDOVER Donkeys/Mules HEALTH DEPARTMENT Stable use: Private C Boarding C Training O Rental,9 Lessons O (r Name of Applicant(PLEASE PRINT) Signature of Aff1deant Contact Phone Numbers(indicate cell;home;work, etc.) AM c- 2 Y O 7.5 3 FEE: 3$ 5.00 Please make check payable to: Town of North Andover(mail to above address) IF NOT RENEWED BEFORE MARCH 1sT,THE FEE WILL BE DOUBLED TO$70.00 Information requested by the Department of Agricultural Resources Bureau of Animal Health—Form 74-500 BKS—7103—4DBSBBI- Commonwealth of Massachusetts City/Town of System Pumping Record FSEP -7 2010 Form 4 w" TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Oth WEA TW ART he information must be,substantially the same as that provided here. Before using this form,check with your local Board of Health tQ determine the form they use.The System Pumping Record must be submitted to the local Board of Health oFath r approving authority. A. Facility Information 1. System Loc : Left side of house, Right side of house, Left front of house, Right front of house, rear of house ight rear of house. Left rear of building. Right rear of building. Address Citylrown State Zip Code 2. System Owner: Name Address(if different from location) Cityrrown State Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: tv� Uxi 6_ System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: G.L.S.D Lowell YVastpWater Signature of Vau#r t Date t5form4.doc•06103 System Pumping Record•Page 1 of 1. TOWN OF NORTH ANDO SYSTEM PUMPING R O 3 0 2005 AUG Noov�R DATE: Np��PR MENS SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) vwll cr- < < a DATE OF PUMPING: QUANTITY PUMPED O GALLONS JCESSPOOL: NO YES S PTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: �`C�S©✓1 COMMENTS: CONTENTS TRANSFERRED TO: �' Address 11 �T Q ST Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and nDtes action Document/ document/ Num. Action Department i Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department Gf Commonwealth of Massachusetts Massachusetts System Purnping Record System Owner System Location 1`J Date of Pumping: /oQuantity Pumped: `�S gallons Cesspool: No Yes LI Septic Tank: No L) Yes L I System Pumped by: FecreQ4rt gitrmplidP,a License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: r - _ 4 ' O Commonwealth..of Massachusetts RECEIVED City/Town of System Pumping Record SEP 14 2006 Form 4 TOWN OF NORTH ANDOVER �� '•�' HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of-Health or other approving authority. . .A. Facility Information .Important: When filling out 1. System Loca forms on the computer.-use J " only the tab key Address to move your � . �-- cursor-do not _ e use the;retum CityfTown State Zip Code key. 2. System Owner. - Name tml Address(if different from location) CityrTown State Kw-Code. fielephone Number I B. Pumping Record 1.: Date.of Pumping Pate 2. Quantity Pumped: Gallons .3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes D46 If yes, was it cleaned? ❑ Yes: ❑ No 5. Condition-of System- 6. System P m ed Name Vehicle License Number Company -- 7. LocVan wh a' ere con` w posed:: I � f� i `"Q Sig at Hauler Date htt :// www.mass: ov/de 1wa r/a e royal 1 P s t5forms:h tm#" 9 p pp Ins ect p t5form4.doc•06103 System Pumping Record Page 1 of 1 SOIL PROFILE & PERCOLATION TEST DATA Tow�it No.&Street �. r Y ee C Lot No. Loc./Subdiv. Plan Owner 000) Investigator ',e-) ®/�C/ Observer SOIL PROFILES-DATE ` fA-177 Eleven Elev, 3° Elev°_ 4°Eley. 0 p 0 p . 2 - t 2� 2 3 y 13• i 3 Inj 4_ ,.. 4 W4 e 5 .5 5 6INN )ZI i 6 . 6 7 7 7 8 8 8 8 9 9 , 9 r 10 10 10 10 Benchmark Location Elevation Datum Percolation Tests-Date Pit Number 1 2 3 4 5 Start Saturation Soak-Mins. J ,. Start Test-Time Drop-of 7'-Time Dro of 6"-Time Mins°lst 3110ro Mins.2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates', North And. ,T)-4Tu T, iIt'IiF.ZC?: ' q. bpi F x 2 w•a. • ...... �lS' f� • ® X -.. c'. +..ri_�.�tn' `-ar.•..e,....+ww...+a»r+,.:.r _..—�..- �__.�.—� ..�� � ter_• ..,� -" -77le, i1 TO: NORTH ANDOVER, MASS -Sem f" /.3 19 7 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection. This is to certify that I have inspected the construction of the said disposal system at 1�r pole/ G= Yvk& North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 77. 60,6L,11-7 I Reg. Prof. Engineer/Reg. Sanitarian ,10RT1� O`tta° y�ti 3? BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 or 52 January 16, 1992 Mr. David J. Young 112 Foster Street North Andover, MA 01845 Dear Mr. Young: The Health Office recently became aware that animals are being kept on your property at 112 Foster Street. Please be aware that anyone having more than three of any kind of animal or bird other than domestic pets, must obtain a permit from the Board of Health Office. The annual permit fee is $25.00 payable to the Town of North Andover. Please fill out the enclosed application and mail with the appropriate fee to the North Andover Health Department, Town Building, 120 Main Street, North Andover, MA 01845. If you have any questions in connection to this permit, please contact me at the number above. Very truly yours, c Allison C. Conboy, R.S. CHO Health Administrator ACC/cjp Enclosure TOWN OF RFCEIVED SYSTEM PUMPING G RECO SEP - 3 2004 DATE: 51 V TOWN OF NORTH ANDOVER II HEALTH DEPARTMENT t/ SYSTEM OWNER& ADDRESS SYSTEM LOCATION ll (example:left front of house) , Uva ` CA 6 �Oust DATE OF PUMPING: QUANTITY PUMPED : f C) 0'0 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES IZ NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste FOR 14- SYSTEM PU.N PLUG RECORD P�aoo� Commonwealth of Massachusetts Massachu System Pumping Record System Owner Svstem Location Date of Pumping: '— _ l J Quantity Pumped: / allons P g� Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by- _ License #: Contents transferred to: ' Date Inspector Commonwealth of Massachusetts , p .Cr �j' Massachusertt$) i 0 a•A�M System Pumping Record System Owner System Location Date of Pumping: ( r 1 C Quantity Pumped: l gallons Cesspool: No '1' Yes L.) Septic Tank: No Yes � c System Pumped by: $Qt'e4ort ga&,�ftaed License # Contents lransferrred to : Greater Lawrence Sanitary District Dale: Inspector: I I I TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) c DATE OF PUMPING: QUANTITY PUMPED 1606 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: / 5 I�iit COMMENTS: CONTENTS TRANSFERRED TO: ell �� . Commonwealth of Massachusetts City/Town of RFZFiVFD System Pumping Record AUG - a 2007 Form 4 DW N OF NORTH ANDOVER DEP has provided this fora for use by local Boards of Health. 1aer3orms�ay�iu§6d pt the rm infoation must be substantially the sante as that provided he6u.�ore using this form,check with your local Board of Health to determine the fort 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 1. System Locati � �i'-",' forms on the l computer,use only the tab key Address to move your cursor -do not use the return Citylrown State Zip Code key--�� 2. System Owner: V' =� Name Address(if different from location) CitylTouvn Statea 3__CZZip Code Telephone Number B. Pumping Record � 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank Other(describe): 4. Effluent Tee Fitter present? ❑ Yes 9-lgo- If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: V\ 6. System um Name Vehicle License Number Company 7. Locatio eri conte eri !!Posed: 7 ♦ J Sign uler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i REC.E VI E� Commonwealth of Massachusett City/Town of FAUG 1 1 2009 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT M 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 Important: When filling out 1. System Location: Left front of house, Right front of house, Left rear of house, i ht r ar of house forms on the computer,use only the tab key Address to move your �V cursor-do not use the return City/Town State e Zip Code key. 2. System Owner: rah G Name Address(if different from location) City/Town Sta C � —5 Telephone Number B. Pumping Record ' � 1. Date of Pumping Date Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Locatio here contents were disposed: 7.L.S.D Lowell Waste Water _Lf Signature of Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts s City/Town of kv% System Pumping Record Form 4 -\CSE P��N DEP has provided this form for use by local Boards of Ht . r forms may be used, but the information must be substantially the same as that provided ere. 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 1• SySte Locat forms on the computer, use only the tab key Address 1 ria to move your cursor-do not Cityfrown State Zip Code use the return key. 2. System Owner: Name ►�I Address(if different from location) Citylrovun StatZip C Telephone Number B. Pumping Record --Ct- 1. Date of Pumping � 2. Quantity Pumped: Date Gallons 3. Type of system: ❑. Cesspools) peptic Tank ❑ Tight Tank ❑ Other(describe): �,� 4. Effluent Tee Filter present? Elham Yes 'No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: V\D A/Va--� 6. System Pum Name —� Vehicle License Number Company 7. Location re contents were osed: L - Signat r. of a ler Date t5fonn4.doc^06/03 System Pumping Record.Page 1 of 1 1 ICN Commonwealth of Massachusetts City/Town of W° System Pumping Record �`���`��� Y p g Form 4 SSP all �M DEP has provided this form for use by local Boards of Health. Other form OVER information must be substantially the same as that provided here. Before si A I your local Board of Health to determine the form they use. The System Pumping ecord must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. Syste : Left front of house, right front of house, left side of house, right side of housed ar of house t rear of house, left side of building, right rear of building, under deck. Cityfrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Star r-, Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of St�v)J� 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Locati n where contents were disposed: . .S ell Wa ter Sign r f H uler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 CED Commonwealth of MassachusE ttS (; 1 City/Town of LE N OF NORTH ANDOVER System Pumping Record ALTH DEPARTMENT yForm 4 DEP has provided this form for uset 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: Left/Right front of house, Left(Fght rrbar of house Deft/right side of house, Left/ Right side of building, Left/Right front of building, Le Ig t rear of building, Under deck Address Cityfrown State Zip Code 2. System Owner. U,EA Name Address(if different from location) Cityfrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Dae 2 Quantityumpe Pd: Lc)C) Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo re contents were disposed: C .'S. Lowell Waste Water Sin t e Haule i 9 Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 I Commonwealth of Massachusetts City/Town of 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. A. Facility Information 1. System Location: Left/Right front of house, Left ight rear of hou . , Left/right side of house, Left/ Right side of building, Left/Right front of building, a Ig rear of building, Under deck AddressQ�.0 Citylrown v State /l J� Zip Code 2. System Owner. Name Address(if different from location) CitylTown State�sC de Telephone Telephone Number-. i B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: El eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Ye. No If yes, was it cleaned? ❑ Yes ❑ No: " 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 RECEIVED Name Vehicle License Number Bateson Enterprises Ince Nov 19 2013 Company TOWN OF NORTH ANDOVER 7. Location where contents were disposed: HEALTH DEPARTMENT G.L S. Lowell Waste Water Sign a Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 r - 112 FOSTER STREET 210%104_D-0027-0000.0 i