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Home My WebLink AboutMiscellaneous - 289 STILES STREET 4/30/2018 (2)y3 � / - �__�_-----_ 'C'*N Rtdgjj��r Commonwealth of Massachusetts D City/Town of NO. ANDOVER J System Pumping Record JUL 12 2006 Form 4 TOWN FN THALN�F30\J/ER HEALTH Dr- RTMENT 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 ReGOrd must be submitted to the local Board of Health or other approving authority. 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD , H79 406 Vehicle License Number 6/22/06 Date t5form4.doc. 06/03 System Pumping Record - Page 1 of I A. Facility Information Important: When filling out System Location: forms on the computer, use 289 STYLES ST. only the tab key Address to move your cursor - do not NO.ANDOVER MA 01845 - use the return City/Town State Zip Code key. VQ 2. System Owner: MARY HOEHN Name Address (if different from location) CityfTown State Zip Code Telephone Number B. Pumping Record 1 . Date of Pumping 6122106 2. Quantity Pumped: 2000 Date Gallons 3. Type of system: El Cesspool(s) Septic Tank5' El Tight Tank El Other (describe): 4. Effluent Tee Filter present? E] Yes R No If yes, was it cleaned? El Yes n No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD , H79 406 Vehicle License Number 6/22/06 Date t5form4.doc. 06/03 System Pumping Record - Page 1 of I "ORTh NUM13ER COMMONWEALTH OF MASSACHUSETTS BHP -2007-0033 0 North Andover FEE Board of Health DATE ISSUED CHU tl Mary Hoehn March 01, 2007 ------------------------------------------------------------------------------------------------------------- NAME 289 STILES 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, 2008 unless sooner suspended or revoked. RESTRICTIONS: 12 Acres: 2 Horses; Private $35.00 ------------------------------------------------------------ Board of ------------------------------------------------ ----------- Health -------------------- n L --------- NOTES: Contact: Mary Hoehn: 978.688.6652 -fl- ---------- --------- ------------------------------------------------------ ,AORTol % 0 0 4 Town of North Andover HEALTH DEPARTMENT 34 U CHECK #: -5—e 7&I,> DATE: LOCATION: 1-1/0 NAME: CONTRACTOR NAME: Type pf ermit or License: (Check box) 13--"A-nimal • Body Art Establishment $ • Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type. $ 0 Funeral Directors $ 0 Massage Establishment $ 0 Massage Practice $ 0 Offal (Septic) Hauler $ 0 Recreational Camp $ 0 Sun tanning $ 0 Swimming Pool $ D Tobacco $ • Trash/Solid Waste Hauler • Well Construction $ SEPTIC Sustems: 0 Septic - Soil Testing $ 0 Septic - Design Approval $ 0 Septic Disposal Works Construction (DWC) $- 13 Septic Disposal Works Installers (DW[) $ 0 Title 5 Inspector $ 0 Title 5 Report $ 11 Other (Indicate) $ 2332 Health Agent In-itials, White - Applicant Yellow - Health Pink - Treasurer ,AORTH ,,,U 0 , .. TOWN OF NORTH ANDOVER 0 Office of COMMUNITY DEVELOPMENT AND SERVICES Argo HEALTH DEPARTMENT 'S C U 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@townofhorthandover.com Animal Permit Form www.townofnorthandover.com The undersigned hereby applies for a permit to "KEEP CERTAIN ANWALS 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 ofHealth and Zoning Bylaws. ,-- I z 5V-1-1- ADDRESSILOCATIONOFANIAMLS: 0 WNER'S NAME: OWNER'S ADDRESSILOCA TION IF DIFFERENT. 9 Dealer: Yes N Adult Young (number of) TOTAL ACREAGE: 1. Cattle (Adult = 2 years & over) Dairy Beef 7. Poultry: Chickens Turkeys Steers/Oxen 8. Rabbits: 2. Goats (Adult = I year & over) 9. Other: 3. Sheep (Adult = I year & over) 4. Swine: Breeders Feeders 5. Llamas / Alpacas 6. Equines: Horses / Ponies Donkeys / Mules Stable use: Private X_ Boarding L7 Training L7 Rental L7 Lessons L7 RE"43*EIVED FEB 2 8 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT z%� S 24� - 'game of"Applicant (PLEASE PRINT) vSignature of�pplicant 1-� — Contact Phone Numbers (indicate cell; home; work, etc.) /L 7,;/ "28 �'7 1 -?13 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- 'R'00T'h C-)mmonwealth of Massachusetts JIM North Andover Board of Health $44, 1600 OSGOOD STREET BUILDING 20; SUITE 2-36 NORTHANDOVER,MA 01845 DATE PRINTED 02/20/2007 ESTABLISHMENT NAME: File Number: BHF -2004-000154 RE: 2007 LICENSE RENEWAL LOCATED AT: 289 STILES STREET NORTHANDOVER,MA 01845 OWNER: Mary Hoehn ANIMAL LICENSE Mary Hoehn 0 Gray Road ANDOVER MA 01810 PHONE: (978) 688-6652 RENEWAL FEE DUE: $35.00 LATE FEE AFTER MARCH Ist - INCREASE FEE TO $70 PERMIT TYPE FEE DURATION: ANNUAL SEASONAL TEMPORARY Animal $35.00 RESTRICTIONS: 12 Acres: 2 Horses; Private NOTES: Contact: Mary Hoehn: 978.688.6652 Total Fees: $35.00 This is a courtesy reminder .... your 2006 Animal License expires on Thursday, March 1, 2007. 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 pen -nit. Application and fee must be returned to: Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 0 1845 no later than Monday, February 26, 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 I st. 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 C?)MMONWEALTH OF MASSACHUSETTS V North Andover 20-0 �- I Board of Health NUMBER BHP -2006-0043 FEE $35.00 DATE ISSUED Mary Hoehn March 01, 2006 ------------------------------------------------------------------------------------------------------------- NAME ------------------------------------------------------------------ 289-ST-ILES STREET ---- ------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A Animal LICENSE Animal This pennit is granted in conformity with the Statutes and ordinances relating thereto, and expires February 28, 2007 unless sooner suspended or revoked. RESTRICTIONS: 12 Acres: 2 Horses; Private ------------------------------------------------------------ �__i Board of Health ------------------ NOTES: Contact: Mary Hoehn: 978.688.6652 -----_---------------------- -------- ------------------------------------ Town of North Andover Health Department Date: I Location: (Indicate Address, if I�e'sridential, -or Name of Business) Check #: Tvve,of -Permit or License: (Circle) 1-1 >(� 4A;im�al vs > unipster > Food Service - Type.- > Funeral Directors > Massage Establishment > Massage Practice $ );> Offal (Septic) Hauler $ > Recreational Camp $ > SEP77C PERMITS: Ll Septic - Soil Testing $ Ll Septic - Design Approval $ L3 Septic Disposal Works Construction (DWQ $ Ll Septic Disposal Works Installers (DWI) $ > Sun tanning $ > SwimmingPool $ > Tobacco $ > TrashlSolid Waste Hauler $ > Well Construction $ > OTHER: (Indicate) 1428 Heaith Agent Initials White - Applicant Yellow - Health Pink - Treasurer �. V%ORTH TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT c" 400 OSGOOD STREET 978.688.9540 - Phone NORTH ANDOVER, MASSACffUSETTS 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 thn T f North Ze o go -L Andover, in accordance with Chapter III, Section 23, 131 and 143 of the Gen I thi7ls-Eananswt; to t e rules and ��e regulations of the local Board ofHealth and Zoning Bylaws. It.. ADDRESSILOCATION OF ANIMALS: ag-q 5 f I'les T FEB 2 8 2006 0 WNER'S NAME: McArLA Noel ri �fMNAjtq r)F NjRTH ANI_,OVER OWNER'S ADDRESSILOCA TION IF DIFFERENT. - Dealer: Yes No_k 1. Cattle (Adult = 2 years & over) Dairy Beef Steers/Oxen 2. Goats (Adult = I year & over) 3. Sheep (Adult = I year & over) Adult Young (number of) 4. Swine: Breeders 0 0 1 Feeders a 0 5. Llamas / Alpacas 6. Equines: Horses / Ponies Donkeys / Mules 1") 0 Stable use: Private )( Boarding L7 Training L7 Rental L7 Lessons L7 mcir!j Name of AppAcant (PLEASE PRINT) TOTAL AC REAGE: I C� 7.Poultry: Chickens 8. Rabbits: 9. Other: --441111 &1-1� Signatu;e of/App�Acant Contact Phone Numbers (indicate cell; home; work etc.) q ? �-�o 9-F - bb 5' �L FEE: $35.00 Please make check payable to: Town of North Andover (mail to above address) Turkeys 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- 4 - SYSTEM PUMINNG RECORD Commonwealth qf, assachuseus 9 Aas. asscachusetts OF NORT4 - AMil- POAFFn OF �ninvv Record -.A Type: Emergency 0- Routine 0' Cesspool: No 9 Yes El Septic Tank: No El Yes LK Date of Pumping: -,q gallons Quantity Pumped: Z System Pumped by (Company): 45Z //_9 Permit 4: Contents transferred to: Contents disposed at: Date Pumper Signatur AZ- -14 y Condition of system/other comments: I I�L 0 C� —101-�I - -r // 0 WDEP APPROVED FORM - 12107195 TOWN OF NORTA AkDOVE BOARD OF HEALTH Location Permit Food Service Retail Food Limited Retail Seasonal Disposal Works Installers Disposal Works Construction Soil Testing Design Approval Permit Dumpster Permit Burial Permit Swimming Pool Permit $ Animal Permit--�- $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 6 Ur) L 8 -Z::2 �-/� Health Agent Vihite - Applicant Yellow - Dept. Pink - Treasurer I , t. TOWN OF NORTH ANDOVER BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 TELEFHONE# (978) 688-9540 APPLICATION FOR PERMIT TO KEEP ANIMALS AND BIRDS IN NORTH ANDOVER DATE: February 21, 2003 The undersigned hereby applies for a permit to "KEEP CERTAIN ANEWALS AND BIRDS" within the Town of North Andover, in accordance with Chapter H1, 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 LM Location Sig-nat"ur'e of $plicant Total Acreage Ad s ";q dres Date Received Approved By FEE: $25.00 Please make check payable to: Town of North Andover . I k. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF HEALTH Date: March 1, 2003 Permit #107-3A Fee: $25.00 This is to certify that: Mary Hoehn Gray Road Na Andover, MA 01845 is hereby granted an... A IMA N LTERMIT This permit is granted in conformity with the statutes and ordinances relating thereto, and expires March 1, 2004 unless sooner suspended or revoked. Francis P. MacMillan,, M.D., Chairman &MA1,C6L Zze-e� Cheryl Jonathan Markey, Member FORM 4 - SYSTEM PUMTIN E, Commonwealth of Massachusetts Massachusetts FFEEB 1 1 2002 - System Pumping Record ystem Owner �iySterrl Location ---k" J, 9 7 1_51 —ke, q((t Type: Emergency D Routine 0 b Cesspool: No F� Yes Ek� Septic Tank: No El Yes 9--"' Date of Pumping: Quantity, Pumped: Ia 6-()c gallon's System Pumped by (Company): /�Aa Permit #r: Contents transferred to: Contents disposed at: Date Pumper SignatureL_,� Condition of system/other comments: G)006 DEP APPROVED F ORNI - 12/07/9S COMMONWEALTH OF MASSACHUSETTS North Andover Board Of Health NUMBER BHP -2004-0332 FEE $50.00 DATE ISSUED Mary Hoehn March 11, 2004 ------------------------------- ----------------------------------------------------------------------------- NAME 289 STILES STREET ---------------------------------------------------------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A Animal LICENSE Animal This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires March 01, 2005 unless sooner suspended or revoked. RESTRICTIONS: Acreage: 12 Acres; Equines: 2 Adults; Private Stable Use ------------------------------------------------------------ ------------------------------------- -------- ----------- ------------------------- --------- ----- ----- --------- ----------------------------------- --------- ------------------------------------------------------------ Board Of Health �e*' TOWN OF NORTH ANDOVER, BOARD OF HEALTH &1111eq/ Location Permit # ----------- Food Service Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ An ima 1 Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 4 Health Agent White Applicant Yellow - Dept. Pink - Treasurer �Feb 27 04 11:00a -NORTH nNDOVER 9786889542 p.2 4.10 4 0 C, TOWN OF NORTH ANDOVER Office of CONMNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT CHU 27 CHARLES STREET 979.688,9540 - Phone NORTH ANDOVER, MASSACHUSETTS 0 1.845 978,688.9542 - FAX healthdept@townofnorthandover,com Susan Y. Sawyer, REHSIRS www.townofiiortliaiidover.coni Public Health Director February 13, 2004 Animal Permit Form KEEp CERTAIN ANIMALS AND BIRDS within the Town of North The undersigned herebY applies for a permit to ct to the rules and regulations ter III, Section 31 and 143 of the General Laws, and subje Andover, in accordance with Chap of the Board of Health. ADDRESSILOCATION OF ANIMALS:__aV___S -f I OwvEF'S ADDRESSILO CATION IF DIFFERENT: 'San. TOTAL ACREAGE:—/ Dealer: Yes— No_)� Adult Young (number of) 1. Cattle (Adult = 2 years &,over) Dairy 7.Poultry: Chickens— Turkeys— Beef Steers/Oxen 8. Rabbits: 2. Goats (Adult I year &_ over) 9. Other: 3. Sheep (Adult I year & over) 10. please list schedule of inoculations to prevent 4. Swine: Breeders contagious diseases (Attack additional sheets listing the Feeder, information.) 5. Llamas I Alpacas What accommodations are provided to allow 6. Equines: Horses / Ponies' for cleanliness, light, ventilation and water Donkeys / Mules supply? Attach an explanation. Stable use: > Please attach property plan locating structures PrivateX Boardf.ng Training that house the animals, and the dimensions of RentalL" Lessors each structure, indicating - animals housed in each. BOARD OF HEALTH L CL f- 40 e MAR 117 2804, L Signat e 0 ppiicant Name of Appft L'ant(PLI I -ASE PRINT) Contact Phone Number; (indicate cell; home; work, etc.) Three (3) Attachments Requested: Innoculations; Explanation of Accomodations; Plan of Land indicating structures for animals FEE: $25.00 ail to above address) Please make check payable to: Town of North Andover (m CAKy Documents\Perrnit\Permit Applicafions\Animal Application.doc - Information requested by the Department Of Agricultural Resourcev Bureau of Ahimal Health - Form 74. 500 BKS - 7103 - 4DBSBBI r - TOWN OF NORTH ANDOVER RTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01.845 CH Heidi Griffin Acting Health Director FAX T a Fax: 9 //-/ / 7, 7a From: Pages: Phone: Date: Re: 978.688.9540 - Phone 978.688.9542 - FAX 0 Urgent 0 For Review 11 Please Comment 11 Please Reply 11 Please Recycle Please call 978-688-9540 for assistance with any questions. Thank you. Xc: Address File Chrono File 0-7 iA I ,.HP Fax K1220xi Last Transaction Date Time TVe Feb 27 11: 00am Fax Sent Identification 819789218580 Log for NORTH ANDOVER 9786889542 Feb 27 2004 1 1:01am Duration Pages Rtsuft 0:54 2 OK TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET 978.688.9540 – Phone NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9542 – FAX Susan Y. Sawyer, REHS/RS bealthdept@townofnorthandover.com Public Health Director www.townofnorthandover.com Animal Permit Form February 13, 2004 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. ADDRESSILOCA TION OF ANIMALS: OWNER'S ADDRESSILOCATION IF DIFFERENT. - Dealer: Yes— No Adult Young (number of) 1. Cattle (Adult = 2 years & over) Dairy Beef Steers/Oxen 2. Goats (Adult = I year & over) 3. Sheep (Adult = 1 year & over) 4. Swine: Breeders Feeders 5. Llamas / Alpacas 6. Equines: Horses / Ponies Donkeys / Mules — Stable use: Private L7 Boarding [7 Training [7 Rental L7 Lessons L7 Name of Applicant (PLEASE PRINT) TOTAL ACREAG 7 -Poultry: Chickens— Turkeys_ 8. Rabbits: 9. Other: 10. Please list schedule of inoculations to prevent contagious diseases (Attach additional sheets listing the information.) 11. What accommodations are provided to allow for cleanliness, light, ventilation and water supply? Attach an explanation. Please attach property plan locating structures that house the animals, and the dimensions of each structure, indicating animals housed in each. Signature of Applicant Contact Phone Numbers (indicate cell; home; work, etc. Three (3) Attachments Requested: Innoculations; Explanation of Accomodations; Plan of Land indicating structures for animals FEE: $25.00 Please make check payable to: Town of North Andover (mail to above address) CAMY Documents\Permit\Permit ApplicationsUnimal Application.doc – Information requested by the Department of Agricultural Resources Bureau of Animal Health – Form 74- 500 BKS – 7103 – 4DBSBBI THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF HEALTH Date: 2/26/02 Permit # 107-2A Fee: $25.00 This is to certify that: Mary Hoehn Styles Street No. Andover, MA 01845 is hereby granted an... 11 ANIMAL PERMIT 11 This permit is granted in conformity with the statutes and ordinances relating thereto, and expires March 1, 2003 unless sooner suspended or revoked. Gayton Osgood, Chairman Francis P. MacMillan, M.D., Member John S. Rizza, D.M.D., Member 1) TOWN OF NORTH ANDOVER BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 TELEPHONE# (978) 688-9540 APPLICATION FOR PERMIT TO KEEP ANIMALS AND BIRDS IN NORTH ANDOVER DATE: To the Board of Health: p4,-- g 9- C�- & The undersigned hereby applies for a pernlit 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 nf Riniq A 'KT^ lk'e7 P� Loc on Signature of cant . ................... � P /S7� L) - ,—, Total Acreage Address Date Received Approved By FEE: $25.00 Please make check payable to: Town of North Andover '�VOOF Filp ARL) ANQ�- Z-ItJ 0 �FF H EA L 7'-'- " H r; L 41002 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF HEALTH Date: 2/14/01 Permit # 107 -IA Fee: $25.00 Ihis is to certify that: Mary Hoehn Gray Road Andover, AIA 01810 is hereby granted an... ANIMAL PERMIT 'Ibis permit is granted in conformity with the statutes and ordinances relating thereto, and expires March 1, 2002 unless sooner suspended or revoked. Gayton Osgood, Chairman Francis P. MacMillan, M.D., Member John S. Rizza, D.M.D.,, Member -4 FJ T"% A rrU I-Jr,1A ILI. TOWN OF NORTH ANDOVER BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 TELEPHONE# (978) 688-9540 APPLICATION FOR PERMIT TO KEEP ANIMALS AND BUMS IN NORTH ANDOVER To the Board of Health: .n The undersigned hereby applies for a permit to "KEEP CERTAIN ANIMALS AND BIRDS" within the Town of North Andover, in accordance with Chapter 111, 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. 4pe .5 e-,5 Location Total Acreage Signature o&4plicant Address Date Received Approved By Bo/� FEE: $25.00 Please make check payable to: Town of North Andover Location Total Acreage Signature o&4plicant Address Date Received Approved By Bo/� FEE: $25.00 Please make check payable to: Town of North Andover 0 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF HEALTH Date: 3/08/00 Permit # 107 -OA Fee: $25.00 This is to certify that: Mary Hoehn Stiles Street North Andover, MA 01845 is hereby granted an... ANIMAL PERMIT This permit is granted in conformity with the statutes and ordinances relating thereto, and expires March 1, 2001 unless sooner suspended or revoked. Gayton Osgood, Chairman Francis P. MacMillan, M.D., Member John S. Rizza, D.M.D., Member 44 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WU,LIAM J. SCOTT Director 27 Charles Street North Andover, Massachusetts 0 1345 74, '0". - T N*:� SACHU5"' (978) 688-9531 Fax (978) 68S-9542 APPLICATION FOR PERMIT TO KEEP ANIMALS AND BIRDS IN NORTH ANDOVER DATE: c,? - P 9� - e%r�' 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. 44e,6 15rae Location Total Acreage— Date Received Kind of Birds No. Signat of A plicant Address A Approved By BOARD OF HEALTH S'ACHU0 NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Date Permit A permit is requested to: dri 1 11 a well install a pump ---4 Lot # 06a,��Z LOCATION: Tel Owner' Address Aa� .1 1-n W,/ Tel Well ContrctrFM Add. -,5A-1,--1n 1-4 � 4 7 V Pump Contrctr Add. Tel WELLS (To be completed at time of pump test.) Type of well 445/ Use Diameter of well (10 Size of casing Depth of bed rock _Depth casing into bedrock 36 Seal been tested? Yes No Date of tlest Depth of well Water -bearing rock - ILA Delivers GPM for Ile 4 Depth to wa =4. I (how long?) Drawdown S3— feet after pumping ho t GPM Date of completion .9�fAature contractor PUMPS (To be filled in before instCl-lation.). Name &*size of pump__3/��e Type Size of tank-- Pump delivers GPM Pipe used in well: Cast iron (_) Sleeve 4.to protect pipe? ,Yes D a e t Galvanized Plastic Type well seal No gignature installer Date water analysis report submitted to plumbing inspector Board of Health Board of Health Wiring inspector DEC - 7 1999 ................. ...... ...... ............. .......... ............ ....................... :XXX�X.. ................. MARY HOEHAN ANDOVER, MA NEW ENGLAND RADON, LTD. 50 Northwestern Drive, Unit 11 Salem, New Hampshire 03079 WATER ANALYSIS RESULTS 603-893-4260 Fax: 603-893-8163 E -Mail: ner@tiac.net DATE: 17 Nov 1999 LA'B#: 32041 THIS SAMPLE MEETS EPA PRIMARY STANDARDS IN THE PARAMETERS TESTED. These parameters exceed the MCL* or are out of range: Manaanese. Primary Standards are standards that are related to health issues. Secondary standards are aesthethic in quality and should not affect healthy individualst., Tested by: MCL: Maximum Con a ant Level.'.'.� i�u FT NEW HAMPSHIRE STA E� RTIFIED. Certificate #102095-C List of currently certified tests available upon request. YOUNG BROTHERS ---------------- TEST SITE: GREYROAD ---------------------------- (510154.1 PARAMETER RESULTS REQUIREMENTS STANDARD MCL HARDNESS 72.0 75 mg/l 0-75 EPA Soft Water IRON 1.0 0.3 mg/l Secondary MANGANESE 0.31 0.05 mg/l Secondary pH 7.4 6.5 - 8.5 Secondary CHLORIDE 6.3 250 mg/l Secondary SODIUM <20.0 250 mg/l Secondary TDS 50.8 500 mg/l Secondary NITRATES <0.5 � 10 mg/l Primary COLIFORM N/A ABSENCE/100 ml Primary E -COLI N/A ABSENCE/100 ml Primary THIS SAMPLE MEETS EPA PRIMARY STANDARDS IN THE PARAMETERS TESTED. These parameters exceed the MCL* or are out of range: Manaanese. Primary Standards are standards that are related to health issues. Secondary standards are aesthethic in quality and should not affect healthy individualst., Tested by: MCL: Maximum Con a ant Level.'.'.� i�u FT NEW HAMPSHIRE STA E� RTIFIED. Certificate #102095-C List of currently certified tests available upon request. Department of Environmental Management/Division of Water Resources WELL COMPLETION REPORT WELL LOCA (WI '5�1(1.r GEOGRAPHIC DESCRIPTION Address N 130 W of, 7 oe (feet) (circle) City/Town Well owner (road) Address - N S 6�7 W of Tm—,,7 —tenths) (circle) Board of Health permit obtained: yes no 0 intersect. WELL Us Domestil Public 0 Industrial El Monitoring 0 Other_ Method drilled Date drilled CASING Type Length ft. Dia(l. in. Length into bedrock ft. WELL DATA Total well depth 36s- —ft. Depth to bedrock !!V ft. Water -bearing rock/unconsolidated material: Description— Water -bearing ZODQS,.- 1) From 05 To 07 2) From S�—To 3) From (794TO To Gravel pack well Protective well seal: L)171r� Screen: Grout El a0ther I Slot#— length dia. dia. from —to — STATIC WATER LEVEL (all wells) I Static water level below land surface AE ft. Date 11171Y7 WELL TEST (production wells) Drawdown 5:5- ft, after pumping 0 min. at gpm How measured - 1101*19 Recovery ft. after 0 hr. /U7 min. LOG of FORMATIONS COMMENTS -Materials From To Z -0- Driller Ybi-,w6 Firm Address City/Town NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS &D 4AL ..91.1T ........ ..... of ... JVD .10"E This is to Certify that ..... ................ ...... ............ .......................................... ----------- -- - --- ...... . ------- ADDRESS IS HEREBY GRANTED A LICENSE For........ ....... ............ .......................................................................................... ................. -4-0 ........ .. .... ... t -i ............................................................................................... ................................................................................................................... ........................................................ This license is granted in conformity with the Statutes and ordinances relating thereto, and expires -------- .. q.9 .................................. unless sooner suspended or revoked. .............. ...................... ............ ................. ..... ............. . .................................... 19.1.1 ..................... I ............... ............. --------------- ..... FORM 433 HOBBS & WARREN TI .A- BOARD OF HEALTH NORTH ANDOVER, MASS. AnnTTrATTnW FOR WELL AND PUMP PERMIT Date Permit # . ..... A permit is requested to: drill a well install a pump_41_______ Lot LOCATION:-- _S S7' OwnerA Address Tel a Well Contrctri/-Vt;&"�'/1/"//q_Fa Add. 14 Tel Pump Contrctr Add. Tel WELLS (To be completed at time of pump test.) Type of well Diameter of well Depth of bed rock Seal been tested? Yes (_) Depth of well Use Size of casing Depth casing into bedrock No (_) Date of test Water -bearing rock +- I., * ^ Tam +' ='rl Delivers GPM for L;=IJ (how long?) Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation.) Name & size of pump Size of tank Pump delivers Type GPM Pipe used in well: Cast iron Galvanized Plastic Sleeve used to protect pipe? Y\es (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health PfurEing inspector wiring inspector Board of Health tA- 0 a) cn m CL 4-- 0 (1) 4-j F- 0 Cl fu C) FA ,a r. m C a OR z A. 0 ff V E .8 0 S t! lw CL E c 0 m 0 a m Z U) :c wwgN 44 Pt It < IL clD 4j < pt co 44 UD lo GD IL "Ile R BOARD OF HEALTH NORTH ANDOVER, MASS. 3 1999 APPLICATION FOR WELL AND PUMP PERMIT Permit # Date A permit is requested to: drill a well install a pump Lot # F LOCATION: Tel Owner Address _-Rd — "V. Tel Well ContrctrjM_ k;&,q_ q &21A Add. Pump Contrctr Add. Tel— WELLS (To be completed at time of pump test.) Type of well Diameter of well Depth of bed rock Use size of casing Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well water -bearing rock Depth to water Delivers GPM for Drawdown feet after pumping (how longe) hours at GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation.) Name & size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (__) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health �'..j IN UPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 0 1949 (978) 774-2772 SYSTEM OWNER: FORM 4 - SYSTEM PUMPING RECORD _"POMMONWEALTH OF MASSACHUSETTS -� A vloo -, MASSACHUSETTS S YS TEM P UMPING RE CORD SYSTEM LOCATION: ? C9 DATE OF PUMPING: 1,-7 - �� QUANTITY PUMPED: CESSPOOL: NO F7 YES SEPTIC TANK: SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE: 2 INSPECTOR: ;Z 4 m /0(2-0 GALLONS NO ]ZI YES E:l THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF HEALTH Date: 04/26/99 Fee: $25.00 This is to certify that: Mary Hoehn Gray Road Andover, MA is hereby granted an... ANIMAL PERMIT This permit is granted in conformity with the statutes and ordinances relating thereto, and expires March I., 2000 unless sooner suspended or revoked. Gayton Osgood, Chairman Francis P. MacMillan, M.D., Member John S. Rizza, D.M.D., Member Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street 705�9 0 �F-N 6R�TP BOARDOF�- WMLIAM J. SCOTr North Andover, Massachusetts 0 1845 Director �01 FAMT, (978) 688-9531 ,10 , Fax (978) 688-9542 APPLICATION FOR PERMIT TO KEEP ANIMALS AND BIRDS IN NORTH ANDOVER DATE: 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 Lawsl and subject to the rules and regulations of the Board of Health. Kind of Animals No. Location Total Acreage A/ Date Received Kind of Birds No. Signa re of Xp-plicant AAA Address 7 Approved By '�N Commonwealth of Massachusetts City/Town of NO. ANDOVER 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 PumDinq Rem. must be submitted to the local Board of Health or other approving authority. F -RECEIIIIED Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. WC] A. Facility Information 1. System Location: 289 STYLES ST. Address NO.ANDOVER City/Town 2. System Owner: MARY HOEHN Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: El M Other idescribe'i: 6/25/08 Date Cesspool(s) 4. Effluent Tee Filter present? F� Yes [ErZNo 5. Condition of System: 6. System Pumped By: Benjamin Shute Name - I s Septic & Drain Company 7. Location where contents were disposed: GLSD .4 JUL 14 2009 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT MA State State Telephone Number 2. Quantity Pumped 04/SeptiG Tank5 01845 Zip Code Zip Code 1500 Gallons Tight Tank If yes, was it Gleaned? El Yes El No H79 406 Vehicle License Number 6/25/08 Date tSform4.doc- 06/03 System Pumping Record - Page 1 of I Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Commonwealth of Massachusetts RECEIVED - City/Town of NO. ANDOVER -toil System Pumping Record ov Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. OtAl Itil [fib I I lay UV U=U' Uut LIM 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: 289 STYLES ST. Address NO.ANDOVER City/Town 2. System Owner MARY HOEHN Name Address (if different from location) Cityrrown B. Pumping Record 1 r)ofdm f%f P" in —z' 3. Type of system: Cesspoolo El Other (describe): 4. Effluent Tee Filter present? F� Yes [9' /No 12/6/10 5. Condition of System: 6. System Pumped By: James H. Currier MA State 01845 Zip Code State Zip Code Telephone Number 2. Quantity Pumped: 1500 Gallons Septic Tank E] Tight Tank If yes, was it Gleaned? n Yes El No H79 406 Name Vehicle License Number J's Septic & Drain Company 7. Location where contents were disposed: GLSD Rure of Hauler 12/6/10 Date t5form4.doc- 06/03 System Pumping Record - Page I of 1