HomeMy WebLinkAboutMiscellaneous - 1267 OSGOOD STREET 4/30/2018 (5) C`,
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�LN Commonwealth of Massachusetts
City/Town of No andover
a
System Pumping Record
Form 4
M
DEP has provided this form for use by local Boards of Health. Other farms 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 I
filling out forms 1. System Loc i:
on the computer, f
use only the tab t U I cr-nv
key to move your Address
cursor-do not —
—
use the return — k - v —— - --- - -
key. City/Town State --- Zip Code
a.Ca.evJ'-5
2. System Owner:
f ,tf � r� n�
Name --r y�
reran I T�tia• ,
Address(if different from location) _ TMENT
Citylrown Stat6 Zip Code
Telephone Number
B. Pumping Record
t11, JI
1. Date of Pumping
Date o C' two
2. Quantity dumped: Gallons
3. Type of system: ❑ Cesspool(s) ZSeptic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 0 No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Name Vehicle License Number
Stewart's Septic Service -
Company
7, Location.,where contents were disposed:
Stew r - atment Plant, 20 So. Mill Bradford, Ma 01835
Signature o Date
re of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts RECEIVE[
_ CitylTown of North Andover CiCj o g 2014
System Pumping Record TOVVNUI-NURIHANDOVER
Form 4 HEALTH DEPARTMENT
wy DEP has provided this form for use by local Boards of Health-Other forms may be used, but the
his , chk with your
information must be substantially the same as that provided here. Before usingRecord fmust be submitted to
local Board of Health to determine the form they use.The System Pumping i date in
the local Board of Health or other approving authority within 14 days from the pumping
accordance with 310 CMR 15.351.
A. Facility Information
Important When
1. System Location:
filling out forms Y
on the computer, ` S
use only the tab
key to move your Address Ma 01886
cursor-do not North Andover Zip Code
use the return State
City/Town
key.
2. System Owner:
Q
�er
Name
Address(if different from location)
State Zip Code
CitylTown
Telephone Number
B. Pumping Record �oG�
2. Quantity Pumped: Gallons
1. Date of Pumping Date
3. Type of system: ❑ Cesspool(s) [ Septic Tank ❑ Tight Tank E] Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No if.yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: Q 9
6. System Pumped By:
Vehicle License Number
Name
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
I
Signature of Hauler Date
i
Signature of Receiving Facility Date
System Pumping Record•Page
t5form4.doc•03/06
- l
pf MpR�TN 4� ; NUMBER
o COMMONWEALTH OF MASSACHUSETTS BHP-2006-0040 of -
• North Andover FEE
* ; $35.00
Board of Health
�'�ti•+•.•^''tc"' DATE ISSUED
Ss�cMuse Barker's Farm Stand March 01,2006
--------- - -------------------------------------- -
NAME j
----------------------- ------------------------ 1267 OSGOOD STREET
ADDRESS
IS HEREBY GRANTED A Animal LICENSE
Animal
This permit is granted in conformity with the Statutes and ordinances relating thereto,and
i
expires February 28,2007 unless sooner suspended or revoked.
RESTRICTIONS: 17 Acres: 8 Goats;Private
-----------------------------------------------------------
( Board of
-------------- -
I�� -- Health '
a
NOTES: Contact:Diane Barker-Coco;978.688.56117
----------- ------------------------------------ ----------
-------------------- ----- ------ ----- -------------
J
Townvf North Andover
Health Department Date:
Location:
(Indicate Address,if R sidential,or Name of Business)
Check#: �_45—c
Type of.Permit or License:(Circle)
Animal
➢ Dumpster $
➢ Food Service-Type: $
➢ Funeral Directors $
➢ Massage Establishment $
➢ Massage Practice $
➢ Offal(Septic)Hauler $
➢ Recreational Camp $
➢ SEPTIC PERMITS:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC)$
❑ Septic Disposal Works Installers(DWI) $
➢ Sun tanning $
➢ Swimming Pool $
➢ Tobacco $
)> TrashlSolid Waste Hauler $
➢ Well Construction $
➢ OTHER:(Indicate) ��
r Oe.
1427 Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
NORTH
T TOWN OF NORTH ANDOVER J A
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENTCHU
CH
SASE
400 OSGOOD STREET 978.688.9540—Phone
NORTH ANDOVER, MASSACHUSETTS 01845 978.688.8476—FAX
Susan Y. Sawyer,REHS/RS healthdept(@townofnorthandover.com
Public Health Director www.townofnorthandover.com
Animal Permit Form
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. n /' _
ADDRESS/LOCATION OF ANIMALS: (U l `J �� hTck, ' � I
OWNER'S NAME: l � e, /�/ D`�/�C t11� �.U g 2006
OWNER'SADDRESS/LOCA TION IFDIFTERENT.• TOWN OF NCRTP-
HEALTH L�
Dealer: Yes No TOTAL ACREAGE:
Adult Young(number of)
1.Cattle(Adult=2 years&over)
Dairy
Beef i 7.Poultry:Chickens Turkeys
Steers/Oxen
8.Rabbits:
2.Goats(Adult= 1 year&over)
9.Other:- Go AT-5
3. Sheep(Adult= 1 year&over)
4. Swine: Breeders
Feeders
5.Llamas/Alpacas
6.Equines: Horses/Ponies
Donkeys/Mules
Stable use:
Private O Boarding O Training O
Rental O Lessons O
i
ame of Applicant(PLEASE PRINT) Signature of Applicant
Contact Phone Numbers(indicate cell; home;work, etc.) S7_
FEE: $35.00
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-
f MURa►, Commonwealth of Massachusetts
?°.�"`° '•*tioo� o North Andover
s �
Board of Health
I
400 Osgood Street
� '� ;;;;�•``,* NORTH ANDOVER,MA 01845
tss4CM0
ANIMAL LICENSE
DATE PRINTED 02/15/2006
ESTABLISHMENT NAME: Barker's Farm Stand
File Number: BHF-2002-0009 1267 OSGOOD STREET
NORTH ANDOVER,MA 01845
RE: 2006 LICENSE RENEWAL
OWNER: Barker's Farm Stand PHONE: (978)688-5617
MAILING ADDRESS: 1267 OSGOOD STREET
NORTH ANDOVER MA 01845
RENEWAL FEE DUE: $35.00
LATE FEE AFTER MARCH 1,2006-INCREASE FEE TO $70
PERMIT TYPE FEE DURATION: ANNUAL SEASONAL TEMPORARY
Animal $35.00 ❑
RESTRICTIONS: 17 Acres:8 Goats;Private
NOTES: Contact:Diane Barker-Coco;
978.683.0785
Total Fees: $35.00
This is a courtesy reminder....your 2006 Animal License expires on Wednesday,March 1,2006. In order to renew your permit,
you must complete the enclosed application and return it along with the renewal fee of$35.00
Please fill.out the enclosed form completely, since applications submitted without the necessary completed information will
delay the issuance of your permit..
Application and fee must be returned to:Health Department,400 Osgood Street,North Andover,MA 01845 no later than
Monday,February 27,2006. Please make check payable to the Town of North Andover.
Please note that the Board of Health will levy a penalty fee by doubling the renewal fee if the license is not renewed by March
1st. Therefore,if your license fee is$35.00,your cost for being late will be$70.00. If this is disregarded,the North Andover
Board of Health may revoke your license,and/or levy an additional fine.
If you have any questions,please call the Health Office at 978.688.9540. Our website is:http://www.townofnorthandover.com.
All regulations and applicable forms can be found on the website as well. If you have any questions,you can e-mail us at:
healthdept@townofnorthandover.com,or call: 978.688.9540.
Thank you for your cooperation during the renewal process.
Enc: Animal License Application Form
NUMBER
COMMONWEALTH OF MASSACHUSETTS BHP-2005-0049
North Andover FEE
Board of Health $25.00
DATE ISSUED
Barker's Farm Stand
February 28, 2005
------------------------------------------------------------------------------------------------------------
NAME
1267 OSGOOD STREET
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A Animal LICENSE
Animal
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires February 28, 2006 unless sooner suspended or revoked.
RESTRICTIONS: 17 Acres: 8 Goats;Private
------------------------------------------------------------
Board of
Health
------------------ ----------
NOTES: Contact:Diane Barker-Coco; 978.683.0785
--------- - --- ---
1,0, r ----------
------------------------------------------------------------
t NORTH 1
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES ^o
HEALTH DEPARTMENTS
CH
?Ss. ustt
400 OSGOOD STREET 978.688.9540—Phone
NORTH ANDOVER, MASSACHUSETTS 01845 978.688.8476—FAX
Susan Y. Sawyer,REHS/RS healthdeptgtownofnorthandover.com
Public Health Director www.townofnorthandover.com
Animal Permit Form
The undersigned hereby applies for a permit to "KEEP CERTAIN ANIMALS AND BIRDS" within the Town of North
Andover, in accordance with ChapterIII, 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. (�
ADDRESS/LOCATION OF ANIMALS: l alo Q S' 6 O d U 7 r e a 'jL
OWNER'S NAME: �Q h f't E8
OWNER'S ADDRESS/LOCATION IF DIFFERENT.-
Dealer: Yes No_I!L-- TOTAL ACREAGE:
Adult Young(number of)
1.Cattle(Adult=2 years&over)
Dairy
Beef 7.Poultry: Chickens Turkeys
Steers/Oxen
8. Rabbits:
2.Goats(Adult= 1 year&over)
9.Other:
3. Sheep(Adult= 1 year&over) j
4. Swine: Breeders
Feeders RECEIVED
5.Llamas/Alpacas FEB 15 2005
6.Equines: Horses/Ponies
Donkeys/Mules TOWN OF NG , ANDOVER
Stable use: HEALTH DE ARTMENT
Private V Boarding O Training 17
Rental O Lessons 17
r2 e /3Q rlCt°f' C 0
Name of Applicant(PLEASE PRINT) Signature of Applicant
Contact Phone Numbers(indicate cell;home;work, etc.) —6 g21
FEE: $25.00
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$50.00
C.I Documents and Settingslpdellechl My Documents)COMMERCIAL PERMITSI Permitl Permit ApplicationslAnimal Application-Rev-2005.doc—
Information requested by the Department of Agricultural Resources Bureau of Animal Health—Form 74-500 BKS—7/03—4DBSBBI-Created on
2/101200512:31 PM
i
Town of North Andover
Office of the Planning Department �$ � to
Community Development and Services Division
William J. Scott, Division. Director
27 Charles Street S^C
North Andover,Vlassachusetts 01845 Telephone (978)688-9535
Heidi Griffin Fax(978)688-9542
Planning Director
o o
NOTICE OF DECISION
--ACDC-)70
Any appeal shall be filed J ��` r
after the
C)�cncam.)
Within(20)days a -0 .c:�r,:=
P.
Date of filing this Notice N 5
In the Office of the Town cry
Clerk
Date: November 17,2000
Date of Hearing: May 16,2000,June 27,2000
August 1,2000 September 5,2000 and November 14,2000
Petition of AT&T Wireless PCS LLC d/b/a AT&T Wireless Services
400 Blue Hill Drive,Suite 100,Westwood,MA 02090
Premises affected: 1267 Osgood Street
Referring to the above petition for a Special Permit with Site Plan Approval. The application was
noticed and reviewed in accordance with Sections 8.3,8.9,10.3,and 10.3.1 of the Town of North
Andover Zoning Bylaw and MGL c.40A,see 9.
So as to allow: The construction of an 80'tall telecommunications wireless service facility in
the Residential 2 Zoning District
After a public hearing given on the above date,the Planning Board voted to APPROVE the Special
Permit with Site Plan Approval,based upon certain conditions which are on file at the Planning
Department and available for review Monday-Friday 8:30-4:30.
1
J
Si gned A
�
Alison Lesearbeau,Chairman
CC: Applicant
Engineer
John Simons,Vice Chairman
Alberto Angles, Clerk
Richard Nardella
Richard Rowen
William Cunningham
BOARD O :,PPEI.:S 6�R-9541. Bt;ILDI�+G 638-9545 CONSEiZVATION 689-9530 HEAL",H 688-9540 PI.,�\ I iCi b88 iii
I
I
Town v.n Of North Andover � NORTH
OFFICE OF
'
COMMUNITY DEVELOPMENT AND SERVICES o A
27 Charles Street
North Andover, Massachusetts 01845 °A•rE° °"'�c5
S
WMLIAM J. SCOTT Ac
Director NOTICE OF DECISION
(978)688-9531 Fax(978)688-9542
Any appeal shall be filled
within (20) days after the
date of filling this Notice
in the Office of the Town
Clerk.
Date: September 8, 2000
Date of Hearing: September 5, 2000
Petition of: AT&T Wireless PCS, 40 Blue Hill Drive, Suite 100, Westwood, MA
Premises affected: 1267 Osgood Street
Referring to the above petition for a Repetitive Petition o o
C) -c
so as to allow: petitioner to re-petition to the Zoning Board of Appeals 0 -ZE m m
m
00
After aublic hearing given on the above date,the Planning Board voted o M o m
P gg g
'0 0:;o LO
=
mx
To: APPROVE the: Repetitive Petition -
0
w
Signed L �_%trait
CC: Director of Public Works Alison Lescarbeau,Chairman
Building Inspector
Conservation Department John Simons, Vice Chairman
Health Department
Zoning Board of Appeals
Applicant Alberto Angles, Clerk
Engineer
File Richard S. Rowen
Richard Nardella
William Cunningham
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
r
1267 Osgood Street—Repetitive Petition
The Planning Board herein consents to allow the petitioner as set forth below to re petition to the
Zoning Board of Appeals. The petitioner is AT&T Wireless PCS, 40 Blue Hill Drive, Suite 100,
Westwood,MA 02090. The petition was submitted on August 4, 2000.
The Planning Board makes the following findings as required by M.G.L. Ch. 40A, Section 16 and
the North Andover Zoning By-Law Section 10.8:
FINDINGS OF FACT:
1. On April 6, 2000, AT&T Wireless PCS filed a petition with the North Andover Zoning
Board of Appeals for a variance from the requirements of Section 8.9.3.6 and 8.9.3.c.ii
(restricting height to 10' above the average building height within 300' or, if no such
.buildings, 10' above average tree canopy height) and Section 8.9. c.v. (requiri�:g
flagpole setback 2x its height and 300'from habitable dwelling or business).
2. On 7/24/00 the North Andover Board of Appeals voted to deny the petition because the
requested variances would be a detriment to the neighborhood and they have not
established (explored) an existing structure that would serve the purpose in another
location.
3. The applicant submitted specific and material changes to their application indicating that
the height of the original application submitted to the Zoning Board of Appeals and the
Planning Board was 120'. The revised application now includes a reduction of height to
80'.
4. The applicant submitted specific and material changes to their application indicating that
the setback to the Barker House of the original application submitted to the Zoning Board
of Appeals and the Planning Board was 142'. The revised application now includes an
increased setback to 150'.
DECISION:
The Planning Board determined that specific and material changes have occurred in the
conditions upon which the unfavorable decision was based,such as the following:
1. The submittal of additional and more specific information indicates that the height of the
proposed wireless facility has been reduced in height from 120'to 80'. This reduces the
height of the wireless facility by 1/3 of its original height.
2. The submittal of additional and more specific information indicates that the setback of
the wireless facility to the Barker House has been increased from 142'to 150'.
3. The above revisions may possibly not be considered a detriment to the neighborhood
when submitted again to the Zoning Board of Appeals.
The Board votes to hereby recommend for allowing the applicant to reapply to the Zoning Board
for a variance(s).
- _ The Commonwealtho f
Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Radiation Control Program
174 Portland Street, 5t" Floor, Boston, MA 02114 .
ARGEO PAUL CELLUCCI (617) 727-6214 (617) 727-2098 - Fax
GOVERNOR
JANE SWIFT
LIEUTENANT GOVERNOR
WILLIAM D.O'LEARY
SECRETARY
HOWARD K.KOH,MD,MPH
COMMISSIONER
June 7, 2000
Joe Sweet
AT&T Wireless Services
400 Blue Hill Drive
Westwood, MA 02090
Re: Cellular Telephone
Dear Mr. Sweet:
Pursuant to-your notification of April 3, 2000, this is to advise you that approval, under
the provisions of 105 CMR 122.021 has been granted to maintain the Cellular Telephone
facility located at 1267 Osgood Street in North Andover, Massachusetts.
Should you have any questions, please contact Robert T. Watkins at (617) 727-6214.
Sincerely,
Robert M. Hallisey, Director
Radiation Control Program
cc: North Andover Board of Health
RMH/RTW%jc
HORTM
Town of North Andover
OFFICE OF 3?Oy steo e,�OL
COMMUNITY DEVELOPMENT AND SERVICES
O ;• A i
27 Charles Street TOWN OF NORTH ANDOVER/ xw
BOARD OF HEALTI-1 79OAITF O-SPP y'�y
9
WILLIAM J.SCOTT North Andover,Massachusetts 01845 SSACHUS�
Director
I'M - 7 1999
(978)688-9531 Fax(978)688-9542
f 1
APPLICATION FOR PERMIT TO KEEP ANIMALS AND BIRDS IN NORTH ANDOVER
DATE: 7G�
To the Board of Health:
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 31 and 143 of the General
Laws, and subject to the rules and regulations of the Board of
Health.
Kind of Animals No. Kind of Birds No.
Zs
Location
Sign re of Applicant
Total Acreage
Address
Date Received Approved By
1
�.
��
C���j
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� 1
STATEMENT Tel. (508) 475-4786
Bateson Enterprises Inc.
111 Argilla Road • Andover, Mass. 01810
N o r 19 9-3-
. r �
Mr . George Barker
1276 Osgood Street
North Andover , Dila . 01845
L J
To insure proper credit please return this stub with your remittance.
AMOUNT$ 250 - 00
DATE DESCRIPTION AMOUNT
11/1/93 Pumped Septic `yank 4 Bradford Street $125 . 00
11/4/93 Pumped Septic Tank Osgood 'street $125 . 00
Bateson Enterprises, Inc. -Andover, MA 01810
)Vathan efts
A'esident �C )L J
«�
508-346-9286 10
Mer,- I"liver 860
i
i
A RESOURCE Inc. ....A Corpor(ction.f0rmo(l to cit; o_(-c iN Waslc
management and environm.en.tally sound ulilizoltoli (V to mn
wastes as a productive agricultural resource,
101 River Rd.
Merrimac, MA 01860
Chairman, Board of HEalth/Health Agent (508) 346-9286
Town Hall
North Andover MA. June 4, 1992
Re: Notification of application of "Beneficial Use" and Type
I liquid gel fertilizer on corn fields and hay fields .
Gentlemen;
Agresource, Inc . , an organic waste management company,
plans to apply several organic by-products of the
manufacture of film-grade gelatine generated by Eastman
Gelatine Corp. of Peabody, Mass . on fields owned and
operated by George Barker, Jr. Bradford St. ; N. Andover.
These organic liquid bone residues have been certified for
beneficial utilization and permitted by Massachusetts
agencies as follows :
Bone Gel approved for land application as an organic
fertilizer and soil amendment by the Mass Division of Solid
Waste Management (Beneficial Use letter dated 10/28/89,
attached) ; and DAF (Dissolved Air Flotation) bone residue by
the Mass . Division of Water Pollution Control (Type I
Approval Letter dated 10/25/90)
These organic by-products have been in beneficial use for
several years on farms in Ipswich, Hamilton, Amesbury<
Haverhill and Middleton, Mass . The materials are subjected
to a regular testing program which includes organic,
inorganic, and TCLP analysis . They are applied from a farm-
type tanker/spreader, and disced or harrowed into the soil
shortly after application.
I have enclosed additional information. The plan is to
conduct a two-week program beginning the week of June 1st.
Please feel free to contact me for any information about
this organic recycling program. We invite you and or any
Board members to witness the application and utilization .of
these products .
continued
page two
You will note that analysis has shown that there are no
contaminants present, including any elements of concern in
groundwater . The amount of material applied is governed
by the recommended Nitrogen requirement of the crop, or
about 200 lbs of N per acre for renovation and/or seeding
with Corn.
nc rely,
Kahfan Tufts, president
encl : Authorization letters and lab analysis data.
/ II
OlAce 1-/1 &Mlc�(
a"me, (?m,,
Brian Donahoe �vucdcan o� �/� irc �1�� �rc 7Da�� ot
Director
�ne i'!'an-lie JGxeel, �oalon, ✓�aoa. 0.��08
October 25, 1990
Frederick J. Roland, P.E.
Technical Director
Roland Associates, Inc.
701 Lee St.
Des Plaines, IL 60016 RE: Eastman Gelatin
LAnd Application
Dear Mr. Roland:
The Department is in receipt of an Application for Approval of
Suitability of bone chip residue generated by Eastman Gelatin
Corporation.. This material is an organic waste produced by an air.
flotation wastewater treatment unit.
In your submittal you have provided process flow diagrams ,
process description, and results of laboratory testirer, of the material
in question. It is proposed that this material eithe' be used as a
soil amendment in a program of direct land application or used for
nutrient and carbon source material for composting operations .
The Department has reviewed the results of analysis from samples
taken on 1/19/90, 2/2/90, 3/2/90, and 3/7/90 and compared these
results to criteria listed in 310 CMR 32 . 12 as well as those
parameters for which drinking water standards or guidelines exist .
Analysis results reveal that the bone residue meets Type I
criteria as defined in 310 CMR 32 . In addition, the concentrations of
a majority of parameters for which drinking water standards exist were
non-detectable.
E-P Toxicity testing was performed and showed the residue to be
non-hazardous pursuant to .tiazardous waste regulations 310 CMR 30 . 00 .
Original on Recycled Paper
In consideration of the process from which the bone chip residue
is derived, and the quality of the waste material itself, the
Department shall regulate further treatment, use, sale, or
distribution of the material consistent with the Regulations for Land
Application of Sludge and Septage 310 CMR 32
. 00. In accordance with
the above cited regulations, the Department hereby classifies the bone
chip air flotation residue as Type 1 to be used beneficially for the
applications specified in your proposal . The Peabody Board of Health
has concurred with the Department classification in a letter dated
September 19, 1990. This determination is governed by the following
terms and conditions.
1. Agresource shall repeat the organo-chloride pesticide
analysis (Method 608) within 6 months of the date of this
letter. Attention shall be afforded to appropriate
detection limits for the parameters of concern. A copy of
the Massachusetts drinking water standards and guidelines is
enclosed for your reference.
2 . The bone chip air flotation residue shall be utilized for
land application purposes only and shall be utilized only at
the site designated by Agresource, Inc. This designation
shall be made known to the Department prior to any actual
land application.
3 . Records of material quantity, quality, destination,
transportation shall be kept and submitted to the Department
on an annual basis with the additional information required
in item 8 below.
4 . Transportation of the residue shall be accomplished in a
manor that prevents spillage of any kind. Tanker units
shall be employed to contain the material and it shall be
enclosed at all times during transportation.
5. Process diagrams submitted as part of the proposal
demonstrate no sanitary connections to this process .
To ensure this to be the case the Department requires
additional testing of the product for indicator organisms ,
namely total and fecal coliform, and salmonella . These
tests must be submitted to the Department within 2
months of the date of this letter and be repeated every 6
months thereafter. In addition Agresource or Eastman
Gelatin shall certify in writing that no sanitary
connections exist in the system that produces the air
flotation material .
6. For the first year of beneficial use, the air flotation
residue shall be sampled on a quarterly basis and analyzed
for the parameters listed in 310 CMR 32 . 13 (5) (e) . This
sampling frequency may be modified pending an evaluation of
the chemical consistency of the material .
• 7• Agresource shall
II
he
requirements of310mCMR 32 . 51with tands32e60nd distribution
8 . 60 (3)and
Agresource shall submit to the Department
Pursuant to 310 CMR 32 . 60 (2) ( ) an annual report
reports shall be due F'ebruarycofathe3calendar year f°llow
the date of Departmental a � ) (b) ' These
pproval of suitability, ing
The Department reserves the right to modify, sus end
its determination based on evidence of any actual o
to public health or the environment or for non-Qom P ith the
or revoke
terms and conditions of this determination, pliance with
Potential threat
Should you have any questions please contact Larry polese of the
Residuals Management Section at (508) 752-8648.
Very truly yours,
y
Brian Donahoe
Director
BD/LP:kt
cc: Nathan Tufts, Agresource
D. Erekson, DEP-Woburn ' 101 River Rd• , Merrimack, MA
A. Deseault, DEP, DSWM, Boston
R• Dunn `
Residuals Management Section
P. Angeramo, Board of Health, 24 Lowell St. , Peabody,, MA
=_ STEVENS ANALYTICAL LABORATORIES, LNG.
° ..' 38 Montvale Avenue, Stoneham, MA 02180, (617) 438-61 H
FAX (617) 438-0173
LABORATORY 'NUMBER: 12584 SAMPLE DATE: 4/19/91
SUBMITTED BY: EASTMAN GELATINE DATE RECEIVED: 4/19/91
227 WASHINGTON STREET
P.O. BOX 473
PEABODY, MA 01960
ATTN: DAVID S. FORTSCH
COLLECTED 8Y: STEVENS ANALYTICAL
SAMPLE SOURCE: LIQUID DUE BESIPUE
REFERENCE: TEST METHODS FOR EVALUATING SOLID WASTE,
EPA SW-846 . TdIRD EDITI2jj„,„.VS�V_EM6EE1.2-5-6 .
DATE DETECTION EPA
(GRABS)
CONCENTRATION PEREORMED LIMIT i�ETHOp
(aRA88) mg/k8
Cadmium ND mg/kg 5/09/91 0. 1 6010
Chromium ND mg/kg 5/09/91 0 . 4 6010
Copper ND mg/kg 5/09/91 0 . 1 6010
Lead 2',3 mg/kg 5/09/91 1 . 0 6010
Silver ND mg/kg 5/09/91 0 , 2 601C
Aluminum 4 . 2 mg/kg 5/09/91 1 . 0 6010
Zinc 1 . 1 mg/kg 5/09/91 011 6010
Molybdenum ND mg/kg 5/09/91 o . 2 6010
Boron ND mg/kg 5/09/91 2 . 0 6010
Arsenic ND mg/kg 5/09/91 1 . 0 6010
Barium 0. 8 mg/kg 5/09/91 0 . 1 6010
Mercury ND mg/kg 5/03/91 0 , 075 747C
selenium ND mg/kg 5/09/91 1 . 0 6010
PH 4 . 79 4/23/91 ---- 9045
PARAMETER CONCENTRATION
(GRABS)
% Solids 17 . 9
% Nitrogen, TKN 910
% Nitrogen, Nitrate 0 . 0013
% Nitrogen, Nitrite 0 . 0018
Phosphorus 0 . 01
Potassium <0 , 0 2
zed },
i
11nn1 ties
on
eNpres:�ed a wet w'�1:
STEVENS
-,-- VENS ANALYTICAL LABORATORIES, INC.
• 38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114
FAX (617) 438-0173
SUBMITTED BY:
EASTMAN GELATIN CORPORATION LABORATORY NO:
12584B
SAMPLE DATE: 4/19/91
227 WASHINGTON STREET
P.O. BOX 473 DATE RECEIVED: 4/19/91
PEABODY, MA 10960 EXTRACTION DATE: 5/01/91
ANALYSIS DATE: 5/04/91
ATTN; DAVID FORTSCH SAMPLE MATRIX: LIQUID SLUDGE
SAMPLE CONTAINER: GLASS
ANALYST: S . MCLEAN
EPA METHOD 8080/PCB/
PESTICIDES
SAMPLE SOURCE: LIQUID BONE RE8_,ZDuE
BESTICID .8 COWNTRA__ TION
Llg/kq DE CN LIMIT
ug/kg
alpha-BHC
gamma-BHC (Lindane)` ND 17 . 9
beta-BHC ND 17 . 9
Heptachlor ND 17 . 9
delta-BHC ND 17 . 9 •`
Aldrin ND 17 . 9
Heptachlor Epoxide ND 17 . 9
Endosulfan Z,. 17 . 9
PrP'-DDE ND 17 . 9
Dieldrin ND 17 . 9
Endrin ND 17 . 9
Pfp'-DDD ND 17 . 9
Endosulfan 1I ND 17 . 9
PIP'-DDT ND 17 . 9
Endrin Aldehyde ND ND 17. 9
Endosulfan Sulfate ND 17 . 9
Chlordane ND 17 . 9
Toxaphene ND 17 . 9
Methoxychlor ND 17 . 9
17 . 9
Aroclor 1016/1242 ND
Aroclor 1221 ND 89 . 5
Aroclor 1232 ND 89 . 5
Aroclor 1248 ND 89 ' 5
Aroclor 1254 ND 89 . 5
Aroclor 1260 ND 89 . 5
89 . 5
Authorized by;
A
11 P(
ND-None Detected Alan P. Stevens, aboratO y-Director
Results are reported on a wet weight basis.
STEVENS ANALYTICAL LABORATORIES, INC. �2
38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114 3
FAX (617) 438-0173 j
SUBMITTED BY: LABORATORY NO: 12584B F
EASTMAN GELATINE CORPORATION SAMPLE DATE: 4/19/91
227 WASHINGTON STREET DATE RECEIVED: 4/19/91
P.O. . BOX 473 EXTRACTION DATE: 5/03/91 D,
PEABODY, MA 10960 ANALYSIS DATE : 5/06/91 T
SAMPLE MATRIX : LIQUID SLUDGE N
ATTN: DAVID FORTSCH SAMPLE CONTAINER: GLASS JAR
EPA METHOD 8150/CHLORINATED
HERBICIDES
SAMPLE SOURCE: ILI, UID BONE RESIDUE
CO PM OUND CONCENTRATION D9TECTION LIMIT
ug/kq ul/kg
2 , 4-D ND 8 . 95
214-DB v ND 8 . 95
214, 5-T . ND 8 . 95
2, 4,5-TP ND 8 . 95
Dalapon ND 8 . 95
Diacamba ND 8 . 95
Dichloroprop ND 8 . 95
Dinoseb ND 8 . 95
MCPA ND 8 . 95
MCPP ND 8 . 95
Picloram ND 8 . 95
Authorized by:
Alan P. Stevens, Laboratory Director
ND-None Detected
Analyses expressed on a wet weight basis .
November ib, 1990
Mr. Larry Polese
DEP - Residuals Management Section
DEP Training Center.
Route 20
Millbury, MA 01527
Dear Mr. Polese:
Eastman Gelatine Corporation produces an organic waste by
an air flotation wastewater treatment system.
The DEP Division of Water Pollution Control granted this
material. a classification as Type 1 sludge suitable for
beneficial use in land applications, in a letter dated
October 25 , 1990 and addressed to Frederick J . Roland .
One provision of this determination was that Eastman
Gelatine would certify in writing that no sanitary
connections exist in the system that produces the air
flotation material .
Eastman Gelatine hereby certifies that no sanitary
connections exist in the system that produces the air
flotation material .
Should you have any question, please contact Jim Thorne at
(508) 531-1700, ext. 103.
Sincerely yours,
Richard J . Harding, Director
Environmental Affairs
RJH:bh
z
Kc: Jim Thorne
EASTMAN GELATINE CORPORATION
P.0.BOX 473•PEABODY MASS.01960-6973 0 69 3 508.531.1700
• i
EXHIBIT A
EASTMAN GELATINE PEABODY PLANT GELATINE TANKAGE F'(.L _ 71 t.1VG
(GEL RESIDUE )
SUMMARY OF LABORATORY DATA
-- ------------------------------------
Laboratory Wds End Nor-east Stevens Nor-east Nor-CdSL
Sample # 1637 . 1 1003 12584 3508 3538
Sample Date 8/11/89 10/13/90 4/19/91 9/06/91 9/21 /91
- --------------------------- - - _ - -- - - --
Physical Parameters
pH 5. 44 - 4 . 79 5 . 71 5 . 3!
% Solids 29 . 5 24 . 4 17 . 9 29 . 8 24 . 8
% Volatile 97. 7 97 . 1 - 97 . 8 98 . 4
Solids
-
Macro Nutrients (mg per liter wet weight total as indicated eitmt-,, L )
TKN ( 1 ) 3700 1830 90 , 000 26 , 380 24 , 743
NH3-N ( 2) - 582 - - -
Phosphorus 100 10 100 - 2
Potassium 500, 2 < 20 - 6
- -
Chemical Components (mg per liter wet weight)
Chloride i62
Sulfate 62 698
Sodium 200 27 940 500
Calcium 2, 800 1280 783 560
Magnesium 200 3 , 635 46
Sulfides
-�— ----------------------------.------------�----------------------- ---------
Fats & .Oils 39 , 866 36 , 925
--------------------- - ----------------------------------------- -- - - - -- - - ----
Conductivity 0 . 8
/ (mmhos/cm)
------------------------------------------ -----------------------------
NOTES:
1 . TKN = Total K,jaheldl Nitrogen comprised of organic
ammonia nitrogen
2 . NH3-N = Ammonia nitrogen as nitrogen
Laboratory Designations
Wds End Woods End Laboratory, Mount Vernon, Me .
Noreast - Northeast EnvironmesiLdl , Lyciu, Md .
Stevens - Stevens Analytical Laboratories , Stoneham , i;d .
EXHIBIT A (cont . )
EASTMAN GELATINE PEABODY PLANT GELATINE TANKAGE RESIDUE,
(GEL RESIDUE)
SUMMARY OF LABORATORY DATA
-------------------------------------------------------------- - - - -- - - -- ----
Laboratory Nor-east Nor-east Represent- Puundc ,
Sample '# 3559 3744 ative Values LoadiciK
Sample Date 10/03/91 (wet wt . ) per 1 , 000 gdi � 3i
Physical Parameters
pH 6 . 14 5 . 6 5 . 5
% Solids 24 . 9 14 . 5 25 . 0 2 , 085
X Volatile 98 . 7 98 . 0 2 , 040
Solids
-------------------------------------------- ----------------------------
Macro Nutrients (mg per liter wet weight total as indicated elcmrnL )
TKN ( 1 ) 27 , 480 14 , 010 20 , 000 167
NH3-N ( 2) 70 58 300 2 . 6
Phosphorus 2 50 0 . 4
Potassium A 10 0 . i
------------------------------------------------------------------------
_.- Chemical Components (mg per liter wet wtj!9h ,)
Chloride 426 < 20 300 2 . 0
Sulfate 1 ,017 600 5
Sodium 510 109 540 4 . 6
Calcium 1, 813 1 , 200 9 . 2
Magnesium 47 50 0 . 4
�--- Sulf ides 23 23 0 . 2
i --
---------------------------- ---------------------------- - --- - - ----
Fats & Oils 25, 195 34 , 000 283
Conductivity --
(mmhos/cm)
-------------------------------------------------------------- - - -- ---------
NOTES:
1 . TKN = Total Kjaheldl Nitrogen comprised of organic ni �rugcll piu�
ammonia nitrogen
2 . NH3-N = Ammonia. nitrogen as nitrogen
3 . Average Application Per Acre
Laboratory Designations
Wds End - Woods End Laboratory, Mount Vernon, Me .
Noreast - Northeast Envirucimec,l.dl , Lycic> , Ma .
Stevens - Stevens Analytical Laboratories , Stoneham , ;d .
EXHIBIT B
EASTMAN GELATINE PEABODY PLANT AIR FLOTATION RESIDLF.
( DAF SLUDGE )
SUMMARY OF LABORATORY DATA
Laboratory Stevens Stevens Stevens Stevens Stevens
Sample # 9469 11861 12452 121758 13702 .3506
Sample' Date 1/19/90 12/13/90 4/04/91 5/15/91 9/16/91 9/'06/'9----------------------------------------------------------------- -- - -----i
Physical
Parameters
PH - 4 . 19 4 . 76 4 . 53 - 5 . 46
X Solids 4. 5 5. 3 6. 0 8. 0 4 . 0 6 . 44
% Volatile - - 73 . 5 89 . 0 95 . 4
Solids
------------------------------------------------------------- ---- -- - -- -- - - -- -
Macro Nutrients (mg per liter wet weight total as indicated
TKN ( 1 ) 150 1 , 100 41 , 000 1 , 850 4 , 700
NH3-N (2) 100 600 - - -
Phosphorus 120 980 2 45 2 , 200 -
Potassium 5 '• , 130 11 18 11 -
---------------------------------------------------------------- -- - -- ---- - ---
Chemical Components (mg per liter wet weight)
Chloride 490 735 560 990
Sulfate 130 100 105 i60
Sodium 336 338 344 425
Calcium i89
Magnesium
�-- Sulfides ND ND ND
---------------------------------------------------------------
Fats & Oils 17, 400 52 ; 180 30 , 790 9i3
------------------------------------------------------------- - - - -- - -- -- -----
Bacteriologic (number per gram)
Total Coliform 91000 40 , 000 93 , 000
Fecal Coliform < 10 20 240
Salmonella Neg
-------------------------------------------------------------
NOTES: 1 . - TKN t Total K,)aheldl Nitrogen
2. Ammonia Nitrogen as N
All Laboratories certified by Massachusetts DEP
- Stevens - Stevens Analytical Laboratories , Stoneham , Ma ,
- Nor-east - Northeast Environmental , Lynn , Ma.
" APPENDIX A 4 of 4
EXHIBIT B ( cont . )
EASTMAN GELATINE PEABODY PLANT AIR FLOTATION RESIDUE
(DAF SLUDGE)
SUMMARY OF LABORATORY DATA
-----------------------------------------------------------.-- ----
Laboratory Nor-east Nor-east Represent- Pounds
Sample #. 3605 3741 ative Values Loading
Sample Date10/11/9111/02/91 (wetwt_ --- -
) per1,000-6d1
- -'----- --- --- - ----
Physical
Parameters
4 .
PH 6 . 11 5 . 46 5 . 0 -
X Solids 5 . 8 5 . 1 6 . 0 500
X Volatile 96 . 1 90 450
Solids
Macro Nutrients (mg per liter wet weight total as indicated � ,
ltzwt-,, . )
TKN ( 1 ) 8 , 729 9360 4 , 000 33
NH3-N (2 ) 979 2030 600 5
Phosphorus 2, 308 11000 8
Potassium 22 15 0 . 1
-----------------------------------------
Chemical Components (mg per liter wet weight)
Chloride 638 434 680 5 , 7
Sulfate 273 260 130
Sodium 274 340 2 , 0
Calcium 120
160
1 . J
Magnesium 12 12 O . i
/- Sulfides Ni 1
Fats & Oils-------------------------------------------------------------
2, 515
20 , 000
167
----------------------------------------------- ----
Bacteriologic (number per gram)
Total Coli , 110 , 000 60 , 000 -
Fecal Coli . < 30 < 30 -
Salmonella Neg Neg _
--------------------------------------------------------- -- ----4
COMPARISON OF EASTMAN DAF SLUDGE WITH EXHIBIT A
MASSACHUSETTS TYPE I SLUDGE/COMPOST QUALITY CRITERIA
Constituent Massachusetts -- --
Eastman DAF Sludge
Concentration
------------------------------------------------------------
____________^_ 1TYpe_I_Limit___________
Cadmium 2 . 0
< 1 . 0
Chromium 1000
5
Lead 300
< 12
Nickel 200
< 3
Zinc 2500 ,,
43
Copper 1000
20
Mercury 10
< 0 . 006
Molybdenum 10
< 2 . 5
Boron 300
< 25
PCB 's 1
0 . 0001
Note: All parameters expressed in mg/kg dry weight
equivalent
a
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OF fsdyWX or
` Development'NSL-3234 w. Socony Mobile Oil Co,., Inc.
DI13438 Osgood St,
2-6-56 Service Station
(With changes aFiS"i .iOiw�lRaTIC 11 FOR. SMIII GE D.-I-S�CSAL 1 F�3��'1'AL A'. 1,111
on plan) HEALTH :; ,rl� 5` ',FN`t--KCrR'.[! ANDOVER; t-PA33.
I hereby make ?plic:atfon for a per-mi.t for a sccra.ge d.ispcs l
installation at r T n�1 s ood t. � I will 3 nstali this
system in _accordance with al t o l-aids of the 0omm:?nweolth of
Massachusetts and regulations of the Board of Health of the Town
of Forth Andover.
Further, I will construct the house cewe.r of bell and, spigot
pipe, the minimum diameter being 4 itches, and will maintain a.
minimum grade of 1% until. 1.0 feet preceding the eptic tank, uherr:
the grade shall not: exceed 2%. 1 v9'll install z concrete s apt ,c
tanks?tf �pp hin size. A manhole (s) perimtting easy clean-
ing �ill�bE rovided °x,,ith removable cover (s) of iron or co-acrote
within 12 inches of the ground* sus-face. I will provide subsurftc !
disposal field with open jointed bell and spigot AZkron pipe at-
least
uleast 4 inches in diameter and laid in a series of trenches, the
bottom of which will provide a minixrzua., of -21a..ft .,, , Unc;wl (2 drainage
(max ) feet of effective absorption area. fine p1pes will be _1a,*-r' fields)
on a 6 inch layer of washed gravel or crushad stons ranging in
size from 3/4 to 1. 1/2 inches (dia. ) and the pipes will be
surrounded by sits:lay:° material to a height of 2 inches above the
crown of the pipe. Tine joints of there pipws will be protected
from clogging and before filling the trench, 2 ineles of gravel
or stone 1/8" to 1./41, (ab. ) will be placed over th--3 course g:rav°el
or stone. The disposal field will be installed at a grade of k.
to 6 inches/100 feet. No single tile line will exceed 100 feet
in length and in any case=, two lines of the will 'ae installed.
A minimum of 6 feet will be maintained betwatsen the center lines c� '
the disposal field trenches and the average depth of trench shall
not exceed 36 inches. No part of the installation will be less
than 100 feet from any private eater supply, 25 feet from any
stream, 20 feet from any dwelling or 10 fee- from any property
line. I further agree not to cover arty oor-ion of this irts i;t7.a.t._E:
un ap�rc�ye __thh ins ec ,'�o�a o�c�f:ger;a;3 prcvi6iec "Tel-
til Md r ..
to incorporate any addition quireffients -What may be attachad V
the permit. Plot Plans must be subniit.ted with application.
DATE
gnatc o7 PP '
I hereby issue the above permit for the Board of Health of r=
April 13,1956
Miss Mary Sheridan R.N.
Health Agent
Board of Health
North, Andover,Massachusetts
Dear Miss Sheridan:
An examination has been mace relative to
the suitability of the soil for the sub-surface dis-
posal of sewage, on the proposed. Osgood. Street
building site of Mr. Barker,
Two percolation tests were made, consist-
ing of 1 minute and 15 seconds and l .minute and 20
seconds. The soil in the area consisted of sand.
It is recommended that two seper. ate systems
be installed, each having a 750 gallon tank with 120
lineal feet of drainage pipe. '
Very truly yours,
Ernest F. Romano
ORT AYlJDOVER MASSACH c
TM ecord SSE
pp �
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING
" MAR 4 2003
�l STEM OWNER & ADDRESS SYSTEM LOC.'AT10N
�f (example: Icft �ron o iou7e)
YC.J 2
-7 �19 c k
U:;"1'C OF PUMPING: a ® QUANTITY PUMP CD /00 Z-2 CALL0
C. 1)00L: NO YES SEPTIC TANK: NO YES
MATURE OF SERVICE: ROUTINE EMERGENCY
(113.>f'RYATIONS: y
GOOD CONDI'T'ION. FULL TO COVER
HPAVY CREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK .
CXCESSI-YE SOLIDS FLOODED
SOLIDS CARRYOVER OAHER (EXPLAIN)
PUMPCD BY.
0J FN'TS:
�.UN l I'.N I'S TJZANSFEIZIZED "T'0:
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Commonwealth of Massachusetts
_ W City/Town of North Andover E-CE11���►�. ,
System Pumping Record
Form 4 I°Lu Q � Nil
M
DEP has provided this form for use by local Boards of Health. Other d rA 1qLQTbW(byRR .
information must be substantially the same as that provided here. B 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 North Anover Ma 01810
cursor-do not
use the return City/Town State Zip Code
key. 2. System Owner:
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record I C\m
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) p is Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. stem Pumped By:
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
wart's Pre-treatme nt, 20 So. Mill Brad rd, Ma 018``35
s'igndture of r Date
Signature Re ' i g acility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
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Massachusetts
yMASSACHUSETTS
;: itylTown of NORTH'ANDOVER,
{° :,Systtn:Punlpirlg Record.
Foran 4 .
DEP has provided this form for use by local Boards of Health. The System Pum P1.tt9 Record must
be submitted to the local Board of Health or other approving authority.
X Facility Information R
ECEIVED
1, System Location, h 11
form:on t1a
Computer,use / TOWDOVERo*the tab key Add H
to mow your A
Y
p CMI
axw•do not , State
return t�ty/Town
use ft key. 2. S Y.stem Owner.
Y �n
Name
I
Address(K different from locallon)
t,ity/rown State Zip Code
Telephone Number
B, Pumping Record
1. Date of PumpingDate 2. Quantity Pumped: Gallons
3. Type of system: [] cesspool(s) e8eptic Tank ❑ Tight Tank
❑ Other(describe):
4.` Effluent Tee Filter present? [IYes I(jJ No.- If yes,was it cleaned? ❑ Yes C] No
5. -Condition of System: .
6. System Pumped B
Vehicle Ucense Number
rVIC0.
7. L=Uon whArq contents were disposed: Efcdjud
o Date
httpJ1www.mass `l ept ►atorlapprovalslt5forms•htm#inspect
t5fom*dood 060 System Pumping Record•Page 1 of 1
I
i' TOWN OP NORTH ANDOVER
SYSTEM PUMPING RECORD
SYSTEM OWNER&ADDRESS SYSTEM LOCATION
(example: left front of house)
I(_�er1
Ce
Gr4d Pj�-` . �'� Str�2CuQfi
6RW�rl�'t!A,','' �`�,.�j t -'`• ' ,�1,✓..� rte"v v� � � .. �
'DAT OF PUMPING: QUANTITY PUMPED J Ody GALLONS
I ,
CESSPOOL: NO YES SEPTIC TANK: NO YES 2—
.,OF
OF SERVICE: ROUTINE ) EMERGENCY
+ l A.� f lR
O
BSERVATIONS.
h
GOOD CONDITION` , FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE _
i ROOTS LEACHFIELD RUNBACK X
r ,
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER_ OTHER(EXPLAIN)
PUMPED DY:,
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rQTS.
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Nr
NM
1/0
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TSFFBRED TO
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i
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F'IC"uf
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TOWN % NORTH ANDOVER RE,CENEC
AUG 0 .
04
SYSTEM OWNER& ADDRESSR
YsTEM i..E?CiTi'ON EN�
TOWN Ur iV:1
HEALTH DEPART� f
CESSPOOL: NO___.-r- -,YES-- ---
SOPtic Tank: NO y'f-S
NATI Kf,4 OF SERVICE: ROUTINE
MhA GENCY
OBSERVATIONS:
GOOD CONDITION _ frLJU,`ro COVEjR
HEAVY GREASE BAFFLES IN PLACE
ROOT'S LEACHFIEEXCESSIVE SOLIDS FLoODEI). D RUT+iBAC.
SOLID CARRYOVER--OTHER EXPLAIN
COMMENTS,
TOWN OF NORTH AN•DUYEk
1.k �� �� SYSTEM PUMPINU RECC)R_D
YSTEM OWNQR �.Ai)DRESS
SYSTEM LOCATTQN
aod-
DATE OF PVWNC: - _QUA NT1TY PUMPED:
Vl;" 'OOL:
.. ...... Sup(ic Ank: Nu. YES..V
NA rvRu ON SERVICE: ROUTINE tM�RU�NC'1'
M--
-SOLrD
VbSERVA'C1UNJ:
GOOD CONDITION PULL 'T'U coVEA �
KRAYY 01 EA313 WYLES IN PLACE
ROOTS ._. LBAACKRELD RUNBACK
SXC6887VE SOLIDS _� P1,pppgD -
D CARRYOVER.._._. OTHER EXPLAIN
)y�t•m PunpeJ by
i
VUMMENTS,
l uN('ENT's fKANvexUL) I'(,