HomeMy WebLinkAboutMiscellaneous - 122 FOSTER STREET 4/30/2018 i
122 FOSTER STREET
210/104.D-0026 0000.0 _
t ___ _ .�_
Commonwealth of Massachusetts
City/Town of
System Pumping- Record
Form 4
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.
A. Facility. Information
1. System Location: Left/Right front of house, Left/Right rear of house, Left/ ' tide of hous eft/
Right side of building, Left/Right front of building, Left/Right rear of building, Under ec
Address
Cityrrown State Trp Code
2. System Owner.
Name
Address(if different from location)
Cityrrown - `
S de
n
t' P7�"7<E�- fir
Telephone Number
i
J
B. Pumping Ricord
1. Date of Pumping . Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yap NO If yes, was it cleaned? ❑ Yes ❑ No.
5. Condition of stem: 9 \ ,^ w
W� (- j v .
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
Lowell Waste Water l j
Sign Haui Date F
t5fbrm4.doe-06103 System Pumping Record•Page 1 of 1
IL
Commonwealth of Massachusetts
City/Town of G - °�T00
System Pumping Record
g` Foran 4 0 N°
N
DEP has provided this form for use by local Boards of Health. er 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:
forms on the
computer,use
only the tab key Address Lt
to move your
cursor- not
use the return Cityrrown Ste Zip Code
key' 2. System Owner:
qQ
Name
Address(if different from location)
City/Town State,,/,7,, Zip Code
Telephone Number
B. Pumping Record —7_-C
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 [ oo If yes,was it cleaned? ❑ Yes ❑ No
5. Conditioo of System:
6. Systeped :
l f
Name Vehicle License Number
Company
7. Location re contents W
a sposed:
Sign re auler Date
t5form4.doc^06/03 System Pumping Record-Page 1 of 1
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner System Location
�5
Date of Pumping: -- �j �� Quantity Pumped: 952,::29allons
Cesspool: No [� Yes [] Septic lank: No [] Yes
System Pumped by: Fa&j4w 46gavMae4, License'#
Contents transferred to: Greater Lawrence Sanitary District
Date: Inspector:
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
DEP has provided this form for us&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/Right rear of house, Left/ I hUsid;ec house Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under c
Address
city/Town State Zip Code
2. System Owner
Name
Address(if different from location)
x
Cityrrown Stag
f{,
J=
Telephone Number ,
- P �
. r.
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 to If,yes, was it cleaned? ❑ Yes ❑ No.
" 5. Condibop o System:
6. System Pumped By:
Neil Bateson F5821 �ECO�/ p�
Name Vehicle License Number "
Bateson Enterprises Inc Nod° .
Company ` `' v 1
7. Location where contents were disposed: THF lOWN oTLH 7a�poVER
4Signe
Lowell Waste Water ANT
ule Date
t5form4.doc•06/03 System Pumping Record.Page 1 of 1
6 AUG 2007
Commonwealth of Massachusetts
City/Town of f CHEACF NORTH LTH DEPARTit D NVE
T ft
System Pumping Record
TjForm 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
Important n
When filling out 1. System LOCatIOn
forms on the
computer,use f��
only the tab key Address �+—
to�move your � �- �. `
cursor do.notCitylTrnnna State Zip Code
use the return
key" 2. System Owner:
vl� �
Name
Address(if different from location)
CityiTo vn State Cade
Telephone Number
B. Pumping Record
1. Date of Pumping date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
El Other(describe):
4. Effluent TeeFilter present? 'I] Yes '90 if yes,was it cleaned? 0 Yes [] No
5. Condition of System (,
6. System Pum 0
Name vehicle I-icense Number
Company
7. Location wh content re/�osed:
-
Sign atu of u Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
VED
Commonwealth.of Massachusetts :wl
City/Town of I SEP 14 .2006
System Pumping Record
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:
filling out 1System. L ation:
fomes the ��
computeto r,use
When \ ;"
only the tab key Address
move your
c . kJ-
usecursor-do not Ci /Town �/
use tFie return tY State Zip Code
key.
2. System Owner:
Name
Address(if different from location)
Cityrrown State
Zi code
Telephone Number
B. Purnpifig Record
1. .Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight.Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 0 No If yes, was it cleaned? ❑ Yes ❑ No
5. ConditionMl' er
6. Syste P m d By:
Name Vehicle License.Number
Compan
7. Locati h eire contents yr erefMVosed::
Signat e u er Date
http://www.mass.gov/dep water/ pprovals/t5forms.htmAnspect
t5form4.doc•06/03II
System'Purhping.Reoord•Page 1 of 1
TOWN OF NORTH AND
SYSTEM PUMPING RECORD
DATE: ��¢
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: 1 -04,> QUANTITY PUMPED_ GALLONS
CESSPOOL: NO J 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)
Ae SYSTEM rUMtE) 1<Y: Sty VN,
COMMENTS:
CONTENTS TRANSFERRED TO: v � )
Address .fo!SZ-6-0 5 Title of File Page of
Date File Open: Date Fie closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes:
action Document/ document/
Num. Action Department
Board.of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department
i
Commonwealth of Massachusetts
Al (fin ✓e i , Massachusetts
Svstem Pumping Record
System Owner System Location
Date of Pumping: f + d Quantity Pumped: '1 Doti gallons
Cesspool: No ... Yes U Septic Tank: . No Ll Yes
System Pumped by: Farejea 5it&¢6vw4 License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: _ Inspector:
Y }
e
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner System Location
Quantity d.
Date of Pumping: Q y Pum ep gallons
Cesspool: No ❑ Yes ❑ Septic Tank: No Yes ❑
System Pumped by: 64&dm 4640 v6d" License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
p4.
.rte"• �``� A�N
I'
Commonwealth of Massachusetts
Massachusetts
Svstem Pumping Record
System Owiter System Location
JT
Date of Pumping: 1— Quaiitily Pumped: gallons
Cesspool: No T Yes Septic 7'aok: No Yes F
System Pumped by: VareoOrc S.Ftreolcoed License #
Contents transferrred to : Greater Lawrence Sanitary Qlstrlct
Date: Inspector:
FORM 4- SYSTEM Pt11PV\G RECORD
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
SN-stern Owner System Location
Date of Pumping: �-�� Quantity Pumped: ��allons
Cesspool: No�-E Yes ❑ Septic Tank: No ❑ Yes
System Pumped b,,-: _ License #:
Contents transferred to: �—
Date Inspector
1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: . !F1
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
(.tl�
1
DATE OF PUMPING: Z L QUANTITY PUMPED ? � 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: aTt
COMMENTS:
CONTENTS TRANSFERRED TO:
TOWN OF - a
SYSTEM PUMPING RECO RECEIVED
D ��_Q`� � SEP
- 3 2004
ATE:
g917�1N O.F NORTH ANDOVER
IWEALTiH DEPARTMENT
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example: left front of house)
U'VWl
(� o - oust
DATE OF PUMPING: QUANTITY PUMPED : 6;�) 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: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D-Z Lowell Waste
Commonwealth of Massachusetts RE:NORTH
D
City/Town of AU09
o System Pumping Record
TOWN OF DOVERForm 4 HEALTHENT
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 side of hous , Right side of house ft front of house, Right front of house,
Left rear of house, Right rear of hou
Address
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town Stab �7jrLCo��--.
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 to If yes, was it cleaned? ❑ Yes ❑ No
5. Condon of System:
6. System Pumped By:
Neil Bateson
Name Vehicle License Number F5821
Bateson Enterprises Inc
Company
7. Location wh re contents were disposed:
L. .D Lowell Waste Water
Snfur4766f Haul r Date
\ t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of
System Pumping Record 0 LP
Form 4p ���
�M
DEP has provided this form for use by local Boards of Health. ht the
information must be,substantially the same as that provided here he with your
local Board of Health tQ determine the form they use. The System Pumping Record mus a submitted to
the local Board of Health motber approving authority.
A. Facility Information
1.' System Location: Left side of hous Right side f hous , Left front of house, Right front of house,
Left rear of house, Right rear of house. uilding. Right rear of building.
Address
City/Town c� State Zip Code
2. System Owner.
Name
Address(if different from location)
City/Town State Zip Code
T lee phone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 2�NoIf yes, was it cleaned? ❑ Yes ❑ No
5. Condi "on of System-
Lx
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location_Whera contents were disposed:
LS.D Low to Wa er
Signature of H ul Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
�LN Commonwealth of Massachusetts
RECE
IVED
W City/Town of
a System Pumping Record SEP
Form 4
TOWN OF N
A TH
DEP has provided this form for use by local Boards of Health. Other for
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 front of house, right front of house, left side of house, right side of house, Left
rear of house, right rear of house, left side of building, right rear of building, under deck.
Cityrrown State, Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town Stater, 0 -,1 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 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition ofoCteu`:
6. System Pumped By:
Neil J. Bateson 175821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Locatio ere contents were.disposed:
G.L".S.D. Lowq#Waste0ater
Signature H 1r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
k
D COMMONWEALTH OF MASSACHUSETTS NUMBER
5� - • BHP-2017-0297
;
^ '
North Andover
BOARD OF HEALTH FEE
$35.00
Twin Oaks Farm DATE ISSUED
Rerrol ' NAME March 01,2017
122 FOSTER STREET
------------------------------------------------------------------------------
------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A Animal Permit
an Animal Permit
This permit is granted in conformity with the Statutes and ordinances relating thereto,and
expires February 28,2018 unless sooner suspended or revoked.
RESTRICTIONS:20 Acres; 50 Cattle; 100 Sheep; 50
Chickens,50 Turkeys BOARD OF
--------------- ------------------------------ HEALTH
NOTES: Steven Young;978.683.0753 or 617.710.9194 d08111
BOARD OF HEALTH CHAIRMAN
`
�
| --'--'-----------------------------------------'---------------'------------'
� !
122 FOSTER STREETReference No: BHF-2004-000156
1 .-
Lfib' '
-mss„
TOWN OF NORTH ANDOVER
Community and Economic Development
HEALTH DEPARTMENT
120 Main Street
NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540-Phone
978.688.9542 FAX
Email:healthdept@riorthandoverma.gov
Animal Permit Form www.northandoverma.gov
The undersigned hereby applies for a permit to "KEEP CERTAIN ANIMALS AND BIRDS" within the Town of Nonh
Andover, in accordance with Chapter III,Section 31 and 143 of the General Laws, and subject to the rules and regulations of
the local Board of Health and Zoning Bylaws. �'
ADDRESS/LOCATION OF ANIMALS: /�o� / 0y?,�- S ,
OWNER'S NAME: S/EUF11/ Val x)G--
OWNER:S ADDRESS/LOCATION IF DIFFERENT
.Dealer: Yes No TOTAL ACREAGE: Ot
Adult Young(number of)
1.Cattle(Adult=2 years&over)
Dairy
Beef 7.Poultry:Chickens Turkeys
Steers/Oxen
2.Goats(Adult=I year&over) 8.Rabbits:_
r-- 9.Other:
3.Sheep(Adult=1 year&over) s So
4.Swine: Breeders
Feeders
5.Llamas/Alpacas
Vr
6.Equines: Horses/Ponies JAN j / 1
Donkeys/MulesZo
Stable use: TOWN OF a
Private O Boarding O Training D HE4LT D� i
�A ii
Rental L7 Lessons O �
13, kVAZ6-
Name of Applicant(PLEA9E PRINT) Signature of Applicant
Contact Phone Numbers(indicate cell;home;work etc.) 7 ee ll On('
FEE: $35.00
Please make check payable to: Town of North Andover(mail to above address)
F NOT RENEWED BEFORE.MARCH 1sT,THE FEE WILL BE DOUBLED TO$70.00
L fernmtion requested by the Department of Agricultural Resources Bureau of Aninud Health—Form 74-500 BKS—7103—4DBSBBI-
��. Commonwealth of Massachusetts
BOARD OF HEALTH
North Andover
120 Main Street RECEIVE®
NORTH ANDOVER,MA 01845
JAN L N17
TOWN OF NORTH ANDOVER
DATE PRINTED 12/19/2016 HEALTH DEPARTMENT
ESTABLISHMENT NAME: Twin Oaks Farm
Twin Oaks Farm 112 Foster Street
File Number: BHF-2004-000156 c/o: Steve Young
NORTH ANDOVER MA 01845
LOCATED AT:
122 FOSTER STREET
,Commonwealth of Massachusetts
OWNER: Steven B.Young PHONE:(978)683-0753
PERMIT TYPE FEE
Animal Permit $35.00
NOTES: Steven Young;978.683.0753 or
617.710.9194
Total Fees: $35.00