HomeMy WebLinkAboutMiscellaneous - 16 BERRY STREET 4/30/2018 (4) JFORM 4-SYSTEM PUMPING RE
CURRIER
SEPTIC & DRAIN SERVICE
107 FOREST STREET; MIDDLETON,MA 01949
(978)774-2772
COMMONWEALTH OF MASSACHUSETTS
,MASSACHUSETTS
SYSTEM PUMPING RECORD
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SYSTEM OWNER: SYSTEM LOCATION
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DATE OF PUMPING: l ^�l g QUANTITY PUMPED: ��d GALLONS
CESSPOOL: NO F-1 YES SEPTIC TANK:. NO F-� YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: j
DATE: 1 r INSPECTOR:
Blackburn, Lisa
From: info@nhdemoIition.com
Sent: Wednesday,July 15, 2015 2:41 PM
To: Department, Health
Cc: 'Jay NHdemolition'
Subject: RE: Notice of crushing
July 15,2015
To Who it may concern,
I would like to notify the North Andover Board of Health that New Hampshire Demolition will be crushing clean concrete
30 days for today at;
16 Berry St
N.Andover MA
I will also be notifying the MassDEP.
If you have any questions or concerns or need additional information,
Please call the office at 603-641-1111
Thank You,
Laura Walters
9M(DemoCtion
792 Londonderry 7pke
Auburn, JW 03032
2: 603.641.1111
T: 603.647.8372
info@nMemolition.com
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ab��M LITI N
Massachusetts Department Of Envircfrfinentai Protection Important:When
Bureau of Waste Prevention - Solid Waste Program this form on a computer,use
only the Tab key to move your
Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR cursor-not the Return key.
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16.03:Asphalt,Brick&Concrete Recycling,Tire Chipping,Shredding or Processing;
Small Composting Operation Not at a Residenal;or Municipal Food Material Collection
I. Property Owner,Operator&Site Information _.
Note:Each box must to be completed for this certification to be valid.Do not leave any box blank.Enter"NIA"if an item is not applica Ile.
Property Owner
Type of Ownership:
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❑Private-Select One: ❑Corporation ❑Limited Liability Corp. ❑Partnership ❑Sole Proprietorship Q(Trust
Public-Select One: p Municipal ❑State ❑Federal ❑Tribal ❑Other—Specify:
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Name of Individu I or Entity -
Tele hone Nber Email Address
VnC5 ii
Mailing Address I
Mme___ _____...___ Q1 __.._---._._______._.
Cityrrown State ZIP Code
Operator -
N CL YN-1 0Ste►t" ._ _� 1_t.. �--
Name
Telephone Number Email Address
Mailing Address 1
At�htv��n M H 005(: 3 2..
City/Town State ZIP Code
Site Information
2110+
Operating Doing Business As(Company Name)
t to .rC-1 _ --- ----�
Street Address(if Differe t from Above)
City/Town State ZIP Code
9 2_ (.o3,z �'`11 _-10_155CC>
Geographic Positioning System(GPS)Coordinates of Activity Location(Example:N42.355800,W71.060114)
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Rev.9113-Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR 15.03-Page 1 of 6 j
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- Massachusetts Department of Environmental Protection
Bureau of Waste Prevention - Sof idWaste Program
Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR
16.03:Asphalt,Brick&Concrete Recycling;Tire Chipping,Shredding or Processing;
Small Composting Operation Not at a Residence;or Municipal Food Material Collection
II.Type of Exempt Activity Requiring Notification
Please check the appropriate box below for the type of activity covered by this notification.A separate notification form is necessary fo
each activity and/or each location requiring a notification to be submitted pursuant to 310 CMR 16.03.If the activity does not meet
the performance standards listed,it is not eligible for Notification pursuant to 310 CMR 16.03 but may be eligible for a General
Permit pursuant to 310 CMR 16.04 or for a Recycling,Composting,or Conversion(RCC)Permit pursuant to 310 CMR 16.05.
Check the appropriate box below for the type of activity covered by this notification:
Asphalt,Brick and Concrete Recycling-310 CMR 16.03(2)tb)5. Complete Sections 111,IV,V&IX of this form. ,
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❑ Tire Chipping,Shredding or Other Tire Processing-310 CMR 16.03(2)(b)6. Complete Sections 111,IV,VI&IX of this form.
❑ Small Composting Operations not at a Residence-310 CMR1,16.03(2)(c)2. Complete Sections 111,IV,VII&IX of this form.
❑ Municipal Food Material Collection Centers-310 CMR 16.03(2)(c)3. Complete Sections III,IV,VIII&1X of this form.
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III. Activity Start Date
1. What is the start date of the activity?(The start date must be no sooner than 30 days after you submit this �S
certification to MassDEP and notify the Board of Health in the appropriate municipality.) Date(r 1NUDD YYY)
2. When and how did you provide a copy of this certification to She appropriate local Board of Health to notify 0-711-5 )
the municipality of the start date? pate of gotificatidn
Method Used:
Email
❑Fax
Regular Mail
IV. General Compliance Requirements(310 CMR 16.03(2)) i
The activities listed in SECTION V through SECTION Vill do not require a site assignment,a facility permit pursuant to 3.10 CMR
19.000,a general permit pursuant to 310 CMR 16.04,or a recycling,composting or conversion permit pursuant to 310 CMR 16.05,
provided that the Owner's and Operator's activities meet the specific applicable requirements in Sections V,VI,VII,and VIII below,anc:
1. The activity will use best management practices.
2. The activity will not have unpermitted discharges of pollutants to the air,water,land or other natural resources of the
Commonwealth.
3. The activity will not create a public nuisance.
4. The activity will not become a threat to public health,safety,or the environment. I
Note.You must check the box below for this notification form submittal to be valid.
I have read this section and the corresponding regulations at 390 CMR 16.03 and will operate in compliance with these and all
other applicable regulations. 1
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Rev.91'13-Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR 16.03-Page 2 of 6
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Massachusetts Department of Environmental Protection
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Bureau of Waste Prevention - Solid Waste Program
Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR
16.03:Asphalt,Brick&Concrete Recycling;Tire Chipping,Shredding or Processing;
Small Composting Operation Not at a Residence;or Municipal Food Material Collection
V. Specific Requirements: Operating an Exempt Asphalt, Brick&Concrete(ABC) Recycling Activity
(310 CMR 16.03(2)(b)5.)
ABC Recycling Activities will be exempt from site assignment and permitting only if:
1. The activity is located at either(choose only one):
❑ An active quarry or active sand and gravel pit where any asphalt,brick,and concrete that is transported to the activity I
is pre-sorted,so it contains only asphalt pavement,brick or concrete rubble;
OR
pD The site of a demolition and/or construction project where all the asphalt pavement,brick and concrete rubble j
"\ processed is generated at the site.Complete a.through d.below:
a. Was an asbestos survey conducted? ]Yes ❑ No
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b. Was an asbestos abatement action completed'? es ❑ No
c. When will crushing begin at the demolition site'? 'Q\ t'712-015
Date M/DD YYY)
d. How long will the crushing continue?
Number R Days
2. The asphalt pavement,brick and concrete consists solely of asphalt pavement,brick and concrete rubble and will not be
mixed with or contaminated by wastes;
3. The asphalt pavement,brick and concrete is asbestos-free and not painted,coated or impregnated with any substance.
4. The asphalt pavement,brick and concrete rubble is processed so the maximum length of the largest dimension of any piece of
rubble is less than 6 inches;
5. All rebar is removed in the process and is recycled in an approved facility;
6. There is no accumulation of the asphalt pavement,brick,and concrete rubble or rebar prior to or after processing,whether in
its as-received,in-process or processed condition,for more than six months from the date of receipt;AND
7. Accurate records are maintained for at least three yearn to demonstrate compliance with 310 CMR 16.03(2)(b)5.
Note:If you are notifying about an Asphalt,Brick and Concrete(ABC)Recycling Activity,you must check the box below for
this notification form submittal to be valid.
I have read this section and the corresponding regulations at MO CMR 16.03 for the operation of an Asphalt,Brick and Concrete
(ABC)Recycling Operation and will operate In compliance with(these and all other applicable regulations.
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Rev.9/13-Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR 16:03-Page 3 of 6
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• Massachusetts Department of Environmental Protection
Bureau of Waste Prevention - Sollid Waste Program
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Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR
16.03:Asphalt,Brick&Concrete Recycling;Tire:Chipping,Shredding or Processing;
Small Composting Operation Not at a Residence;or Municipal Food Material Collection
VI. Specific Requirements: Operating an Exempt Tire Chipping, Shredding or Other Processing Activit
(310 CMR 16.03(2)(b)6.)
Tire Chipping,Shredding or Other Tire Processing Activities shall be exempt from site assignment and solid waste permitting only if.
1. Only tires or tires with wheel rims attached,that are not mixed with other solid waste,are processed;
2. The quantity of whole tires on site does not exceed the number of tires that can be processed in a 24-hour period or 1000 I
tires,whichever is greater;
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3. The total quantity of processed tires(tire chips,shreds or other tire:-derived products)at the site does not exceed five times:#e s
weight of tires that can be processed in a 24-hour period or the equivalent of 5000 tires,whichever is greater;
4. Whole tires and processed tires are stored in buildings,covered containers or otherwise covered to prevent the infiltration o�
water;
,
5. Whole tires and processed tires are stored in accordance with 310 CMR 7.00 and local fire department requirements for t
storing combustible material;
6. There is no accumulation of tires and/or processed tires prior to or after processing,whether in an as-received,in-process or
processed condition,for more than 30 days from the date of receipt;and
7. A copy of this form has been provided to the board of health and local fire department at least 30 days prior to commencemIe t
of activity.
8. The processed tires are only(check all that apply):
❑ Used to make new synthetic polymers("rubbei")t
❑ Used in accordance with a beneficial use determination or other approval required by the Department;
(If a BUD is used,provide the most recent Transmittal Number: )
❑ Combusted in a facility that is not a solid waste:facility and in accordance with a specific air quality approval issued.
under 310 CMR 7.00 that approves the combustion of tires or processed tires as an alternative fuel;
(If an air quality approval was issued,provide the most recent Transmittal Number: )
❑ Transferred to a solid waste management facility approved by the Department;and/or
El Transferred out-of-stake and managed in accordance with that state's laws.
Note:If you are notifying about a Tire Chipping,Shredding or Other Tire Processing Activity, you must check the box belovu
for this notification form submittal to be valid.
❑ I have read this section and the corresponding regulations at 310 CMR 16.03 for the operation of Tire Chipping,Shtedding or j
Other Tire Processing Operation and will operate in compliance with these and all other applicable regulations.
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Rev.9/13-Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR 16:03-Page 4 of 6
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Massachusetts Department of Environmental Protection j
Bureau of Waste Prevention - Sapid Waste Program
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Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR
L11 16.03:Asphalt,Brick&Concrete Recycling;Tire Chipping,Shredding or Processing;
Small Composting Operation Not at a Residenria;or Municipal Food Material Collection
VII. Specific Requirements: Operating an Exempt:Small Composting Operation Not at a Residence
(310 CMR 16.03(2)(c)2.)
Small Composting Operations not at a Residence shall be exempt from site assignment and solid waste permitting only if the activity;:
1. Composts less than twenty cubic yards or less than ten tons per week of vegetative materials,food materials or animal
manures that have been generated on-site;and l
2. Combines such materials with bulking materials(from on or off-site)to achieve effective composting.
Note:If you are notifying about a Small Composting Operation Not at a Residence,you must check the box below for this
notification form submittal to be valid.
❑ I have read this section and the corresponding regulations at 310 CMR 16.03 for the operation of an exempt Small Composting'
Operation Not at a Residence and will operate in compliance with these and all other applicable regulations.
VIII. Specific Requirements: Operating an Exempt Municipal Food Material Collection Center
(310 CMR 16.03(2)(c)3.)
Municipal Food Material Collection Centers shall be exempt from site assignment and solid waste permitting only if the center:
1. ❑ Accepts only food materials from residents of the municipality;
2. ❑ Stares all food material in a container(s)which is(are)kept sealed when food material is not being added;
3. ❑ Accepts no more than one ton of food material per day and no more than three tons are on-site at any time;
4. ❑ Removes food material from the center in a manner that does not create public nuisance conditions,such as,but not
limited to,odors or vectors;and
5. ❑ Does not store or keep food material on-site for more than 7 days after receipt. l
Note:If you are notifying about a Municipal Food Material Collection Center,you must check the box below for this
notification form submittal to be valid.
❑ I have read this section and the corresponding regulations at 310 CMI2 96.03 for the operation of an exempt Municipal Food
Material Collection Center and will operate In compliance m(Ath these and all other applicable regulations.
Continue to Next Pagi o.
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Rev.9/13-Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR 16.0—Page 5 of 6
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® Massachusetts Department of Environmental Protection 1
Bureau of Waste Prevention - Sollid Waste Program
Notification Form for New or Newly Acquired Exempt Activities Pursuant to 310 CMR
16.03:Asphalt,Brick&Concrete Recycling;Tine Chipping,Shredding or Processing;
Small Composting Operation Not at a Residence?;or Municipal Food Material Collection
IX. Signatory Authority
Please review this notification form to ensure that all _
applicable performance standards are agreed to by placing Sig re of Responsible t3fiiciaL
a check or"X"in all applicable sections. If the Owner or
Operator does not agree to,or does not comply with,the print Full Nam
general requirements and applicable specific requirements,
the activities shall not be considered exempt from the site NT
assignment and permitting requirements of 310 CMR 16.00 Title j
and 310 CMR 19.000. 0-7 11612015i I
Date of Notifi tion (MWOO/YYYY)� I
The signatory below shall operate in accordance with 310
CMR 16.03 and this notification.
"I certify under penalty of law that I have personally
examined and am familiar with the information submitted in
this document and all attachments and that,based on my
inquiry of those individuals immediately responsible for
obtaining the information,I believe that the information is
true,accurate and complete.I am aware that there are
significant penalties both civil and criminal for submitting
false information including possible fines and
imprisonment."
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Rev,9113-Notification Form for New or Newly AcquisM Fxempt Activities Pursuant to 310 CMR 16.03-Page 6 of 6
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10-DAY EMERGENCY BEAVER OR MUS IAT PERMIT
Name: D Permit No.4
Address: / z&
r
Authorized Agent Name(if applicable): "Cr
Complaint Location: 3' S %
In accordance with and pursuant to provisions contained in chapter 131 of the Massachusetts General
Laws section 40, 80A and 321 Code of Massachusetts Regulation 2.08 and 10.00
(Wetlands Protection Act),the permittee(s) above named may immediately remedy the threat to
human health and safety by one or more of the following options:
0(ae useconibeaz =�' rcage-type traps for the taking of beaver or muskrat,
cteions promulgated b the Division of Fisheries and Wildlife
(seesubJeto tire�lat
back).
(b) the breaching of dams, dikes, bogs or berms, so-called*
(c) employing any non-lethal management of water-flow devices*
*In cases where option(s) b and/or c are specified, the applicant must appear before the local
conservation commission to obtain an emergency certification regarding specifications for breach
size and/or water-flow device installation in accordance to M.G.L. c. 131, s. 40 (Wetlands Protection
Act)
The Board of Health has determined that said beaver muskrat problem poses a threat to public
health or safety as stated in G. . c. 131, . 8
Specify: 6, cm v
pC e4(f'> Cl/-/ S71 C
Cd r
�s
I Board of Health Official Na
Board of Health Official Signature: G ' Date:
The above signature validates this permit for 10 consecutive days from the date shown for
option (a) only. If the permittee chooses options(b) and/or(c),he/she must return to the
Board of Health for a final signature after obtaining an emergency certification from the
conservation commission.
Please attach the emergency certification to this permit and return to the Board of Health for
final approval.
(See Back)
C:\My DocmnentsWnima11200])BEAVER FORMS OCT 2001110Day Emergency Permit.doc
This permit is valid for 10 consecutive days from the date of the final Board of Health
signature.
Board of Health Official Name:
Board of Health Official Signature:
Start Date:
End Date: Ext:
This permit does not allow permittee(s) or their authorized agent to trespass on private
property.
This permit or a copy thereof shall be carried on the person of any individual exercising the
authority thereof and shall be shown upon request if challenged by any local or state law
enforcement.officer empowered to enforce the provisions of M.G.L. c ,13"1.
Massachusetts Division of Fisheries and Wildlife trapping regulations
Permittee(s) may destroy problem furbearing mammals (named above) by means of a body
gripping trap or by means of a box or cage type trap including Hancock or Bailey traps for
catching beaver, The pan of Hancock and Bailey traps must be submerged in water. Problem
furbearing mammals that are captured alive shall be disposed of by destruction in a humane
manner. Body gripping traps with a jaw spread not less than 4 inches and not greater than 7
inches or body gripping traps with a jaw spread not less than 6 inches and not exceeding 10
inches for the trapping of beaver only, may be used if such traps are completely submerged in
water. The placement of traps in reference to the proximity of the beaver lodge or beaver dam is
unrestricted, but the disturbance or destruction of the beaver lodge or beaver dam is strictly
prohibited unless otherwise authorized.
Permittees) taking problem furbearing mammals, on the property of another, by means of a
trap shall possess a valid Massachusetts trapping license and traps shall be registered
according to M.G.L, c. 131, s. 80.
Said problem furbearing mammals(named above), their carcasses or parts thereof may be
retained by the permittee, sold, bartered, or exchanged for consideration during the open
regulated harvest season for that species. Sealing of beaver pelts is required. Disposition of all
carcasses obtained from the incidental capture of furbearing mammals not authorized by this
permit must be surrendered to the District Wildlife Manager of the Division of Fisheries and
Wildlife having jurisdiction in the town where the furbearing mammal was taken.
CAMy DocumentslAnimal\200 ABEAVER FORMS OCT 2001\10Day Emergency Permit.doc
APPLICATION FOR 10-DAY EMERGENCY PERMIT TO MANAGE
BEAVER OR MUSKRAT THREAT
TO BE FILLED OUT BY APPLICANT Fee(if applicable): $ _;14
Name: T,:2 / f' Date:
Address: X(
Town: p Z/�_ Zip Code:
Daytime Tel. # 9��"fp�,3, f J�g� Evening Tel. #
Agent Name:
Tel. #
(if applicable)
Complaint Location:
Is the problem entirely on your property? Yes: No: Don't Know:
Note: If the problem does not occur entirely on the applicant's property, consent forms from all
other property owners must be obtained.
Complaint Condition: Check appropriate box and provide a detailed description of the perceived threat
to public health and safety
❑ Flooding of drinking water well
❑ Flooding of septic system or sewer
I�Flooding of public or private way or driveway
❑ Flooding of a utility structure such as an electrical or communications facility
Flooding of a building
CAMy Documents/Animals\2001\Beaver FormsWpplication for lMay Emergency Permit.doc
SS/aem
/Flooding poses imminent threat of substantial property damage
Flooding which prevents normal agricultural use of land
❑ Other condition ��7`/ C SS ��
Under M.G.L. c. 131, s. 80A, an emergency permit authorizes the applicant or his duly authorized agent
to immediately remedy the threat to human health and safety by one or more of the following options: (a)
the use of conibear or box or cage-type traps for the taking of beaver or muskrat, subject to regulations;
(b)the breaching of dams,dikes,bogs or berms;and/or(c) employing any non-lethal management of
water-flow devices. The emergency permit will be good for 10 days from the date of issue.
I certify the above information is true and correct to the best of my knowledge
Signature of Applicant: / ✓ Date: 3c) 4�
- - - - - - - - - - -- - -- - --- - -- - - - - ------------- -------- -------------- -- ----- ---=- -
THIS SECTION IS FOR COMPLETION BY NORTH ANDOVER HEALTH AND CONSERVATION DEPARTMENTS
Site visit by Health: Date onspector name:
Approved Permit#04!q,0,4Jtart Date ;3, d ' End Date / i .Date
Permit Denied Date) Z— -off Director Signature
Site visit by Conservation: Date Inspector name:
Conservation Commission Application Required: Yes ! No
Findings&recommendations:
Note: Options(b) and/or(c)above require applicant to get North Andover Conservation Commission
approval prior to such work in accordance with the Wetlands Protection Act.
CAMy Documents/Animals\2001\Beaver Forms\Application for May Emergency Permit.doc
SS/aem
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Commomveatth of Massachusetts
` Im Divmen
of
Fisheries & W
MANSWZidl,ffe
Wayne F.MacCallum,Director
Problem Animal Control Permit
John Flagg Date: January 7,2005
41 Jackson St. Number: 069PAC05
Ayer MA 01432 Cost: $ 100
Expires: Dec. 31,2005
Is hereby authorized in accordance with the provisions of Section 4,Chapter 131 of the Massachusetts
General Laws and Code of Massachusetts Regulations 321 CMR 2.14 to harass,take and destroy or may
release or liberate as stipulated in 321 CMR 2.14(23)by legal means,with the consent of the owner or
tenant,the following species or group of species causing damage or problems to private or public property:
Snapping turtle,Starling,Pigeon,House(English)sparrow, Opossum,
Moles,Bats except those species listed in 321 CMR 8.01, Cottontail
rabbits,European rabbits, Chipmunk, Gray,Red and,Flying squirrels,
Woodchuck,Muskrat,Rats,Mice, and Voles except those species listed
in 321 CMR 8.01,Porcupine,Raccoon, Weasels,Red and Gray foxes,
and Skunk
Problem animals taken alive under authority of this permit shall be disposed of by destruction in a
humane manner,by immediate liberation at the site of capture or by transferal to a licensed
wildlife rehabilitator in the case of a sick or injured animal.
No problem animals or parts thereof(except those taken during the regulated open season and in
compliance with any and all rules and regulations set for the species involved)taken under
authority of this permit may be retained,sold,bartered or otherwise disposed of,except as
provided in this permit,without specific authorization from this office.
This permit must be in the possession of the permittee at all times while engaged in the activities
described herein.The permittee must carry at all times,a Massachusetts hunting,_sporting or
trapping license(and a currently valid trap registration certificate).All traps must be tagged and
numbered in accordance with provisions of law.
A written report shall be sent to this office upon expiration of this permit,no later than January 31,
stating the total number of complaints,the species involved,the number of animals taken,
destroyed or surrendered,the disposition of same and any other information as the Director may
require.
Permittees shall adhere to all provisions of 321 CMR 2.14 unless special authorization or
exemption is given. ,
Wayne F. 1M1acCallum,Director
www masswidcllife ori
Division of Fisheries and Wildlife
Field Headquarters,One Rabbit Hill Road,Westborough,MA 01581 (508)792-7270 Fax(508)792-7275
An Agency of the Department of Fisheries, Wildlife& Environmental Law Enforcement