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HomeMy WebLinkAboutMiscellaneous - 710 SALEM STREET 4/30/2018 (2)N i 9 Commonwealth of Massachusetts North Andover, Massachusetts System Owner & Address: Tim OBrien 710 Salem St North Andover, MA 01845 Location of system: Front Date of Pumping: May 4, 2012 Type of system: Septic Tank Gallons Pumped: 1000 gallons System pumped by: Service Pumping & Drain Co., Inc. S Hallberg Park North Reading, Ma RECEIVED I 1AY 8 20'12 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT License #: BHP -2011-0413,0412,0411,0410,0409,0408 Contents transferred to: Greater Lawrence Sanitary District Date: May 4, 2012 Pumping Technician: CH This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes Commonwealth. of Massachusetts City/Town of 1 System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the -local Board of Health or other approving authority. . A. Facility Information Important: When filling out 1. SysteLocation: forms on he computer, use only the tab key Address Cr+ to move your 0 ( 6 cursor - do not use theretum Cityrrown State 1 2� Zip Code key.2. SDEC ystem Owner: C �A � NDOV�,R3 OF NORppHRYMEN� W pE Name iC l Address (if different from4ocation) CityfrownState Zip Ctide' Telephone Number .B. Pumping Record U_�d T. .Gate of Pumping Date 2 Quantity` Pumped: Gallons 3. Type of system: ❑ Cesspool(s) - eptic Tank_ ❑ Tight:Tank ❑ Other (describe'): 4. Effluent Tee Filter present? ❑ Yes R Ivo If yes, was it cleaned? ❑ Yes `❑ No 5. Condition o System: 1 . 6: System P m eklBy:. !Jame Vehicle t icense Number Company- — . 7. Location ere contentwer posed:: Signa re r Date http://www.mass.gov/dep/w a approvals/t5forms.htm#inspect t5form4.doc• 06103 System Riimpmg Record • Page 1 of 1 TOWN OF NORTH ANDO` SYSTEM PUMPING RECO DATE: 11/15/05 SYSTEM OWNER & ADDRESS TIM O'BRIEN ►� NOV 15 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM LOCATION (example: left front of house) 710 SALEM STREET DATE OF PUMPING: 10/27/05 QUANTITY PUMPED L i o n GALLONS CESSPOOL: NO x YES SEPTIC TANK: NO YES x NATURE OF SERVICE: ROUTINE X EMERGENCY OBSERVATIONS: GOOD CONDITION X FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: RA(;c;s TNc_ P.O. BOX L027 CONCORD, MA )1742 COMMENTS: CONTENTS TRANSFERRED TO: GREATER LAWRENCE SANITARY DTS'T'RT T MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800 Ma Onlv (800) 392-6108. FAX (800) 851-8424 10/11/2006 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.36 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: TIMOTHY J. & MICHELE O'BRIEN Property Address: 710 SALEM ST, NORTH ANDOVER, MA 01845 Policy Number: 0824276 Type Loss: Water Damage Date of Loss: 10/02/2006 Claim Number: 234594 Claim has been made involving loss, damage or destruction of the above captioned propert, which may either exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 RECEIVED OCT 16 2006 70H�ER ,LTH DEP_ ARS NT MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOC!ATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675 08/10/05 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.313 [-7 R -EC. Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139, Section 3 B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 AUG 1 6 2005 NORTH ANDOVER HEALTH DEPT. TOWN OF N^ NORTH ANDOVER TOWN HALL HEALTH NORTH ANDOVER MA 01845 - Re: Insured: TIMOTHY J. & MICHELE O'BRIEN Property Address: 710 SALEM ST, NORTH ANDOVER, MA 01845 Policy Number: 0824276 Type Loss: Theft Date of Loss: 07/28/05 Claim Number: 220146 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139, Section 3 B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 i�o' 1,0 41ANDOVER lovIA,)�r, TOWN OF NORT SYSTEM PUMIANG RECORD DATE Z r SYSTEM. OWNER & ADDRESS SYSTEM LOCATION 0'13 o'eW 7l0 'SaLe)-)) Sr IUD - 0/V o 6 ver -1 rna - DATE OF PUMPING: LQ -.0V QUANTITY PUMPED:_��,f4o CESSPOOL: NO _,/YES Septic Tank: NO YES L-'� NATURE OF SERVICE: ROUTINE L-1%WRGENCY OBSERVATIONS: ae C-,"' GOOD CONDITION FULL TO COVER HEAVY GREASE L,,--BAFFI-ES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER-- OTHER EXPLAIN System Pumped by COMMENTS: CONTENTS TRANSFERRED TO -- 62002 S. APPLICATION FOR LICENSE TO MANUFACTURE FROZEN DESSERTS AND/OR ICE CREAM MIX To the Board of Health of North AndOVer in accordance with the provisions of Section 65H of Chapter94 of the General Laws, as most recently amended and the regulations made thereunder, the undersigned hereby applies for a license for the WHOLESALE/RETAIL manufacture of frozen desserts and or ice cream mix and submits the following information: Name of Establishment: �? YwYm "�`���"k' ...............I.......................................................... Location:.... 2� 5 /. .5�C�.... 57- ..Telephone .................. ,JD ISI �/1 Name of firm:.......(%... �!)..................................................................... Addressof firm:...... �...1..�.... Vr ..............Telephone #................... Owner(s) / Operator(s)................................. ............. . ( .......................................... Type of business: Corporation ( PartnershipOwner Please list licenses, permits, or registrations issued by other municipal, �— �state or federal agencies:.. ..��? 1/1� GD/ .... :...���.. �.................................................................. oducts fqy Number and capacity of freezers................................................................ Make and Model of mixing equipment. l.`���Y� ..� Age .......i.�' V.................. Is the mix purchased?........If so, from whom purchased?......... i Is the mix pasteurized? .......... I..��............................................................. Number of gallons of frozen desserts and/or ice cream mix sold as such in Massachusetts, manufactured during last calendar year..... A1.01V.:.5- ........... Have you received a copy of the regulation?...... Vt�'�......................................... Is the plant constructed and equipped as provided in the regulations?.... ....... Are you manufacturing dairy products?...... ............ Please note: Non- dairy frozen desserts no longer require bacterial testing What is the approved laboratory which will conduct monthly bacteria testing? Name...................................................Address.................................... Do you understand that the laboratory must submit copies of the results to the Board of Health and the NIDPH upon completion of the analysis? ........................ Bacteriological limits for frozen desserts are: 10 coliform colonies per gram 50,900 st arida -d- plate count per grave: I hereby certify that the frozen desserts and/or ice cream mix I sell in Massachusetts will be manufactured in compliance with all laws of the Commonwealth of Massachusetts pertaining thereto and all rules and regulations promulgated by the Massachusetts Department of Public Health made thereunder and will be manufactured under sanitary conditions i Are you manufacturing dairy products?...... ............ Please note: Non- dairy frozen desserts no longer require bacterial testing What is the approved laboratory which will conduct monthly bacteria testing? Name...................................................Address.................................... Do you understand that the laboratory must submit copies of the results to the Board of Health and the NIDPH upon completion of the analysis? ........................ Bacteriological limits for frozen desserts are: 10 coliform colonies per gram 50,900 st arida -d- plate count per grave: I hereby certify that the frozen desserts and/or ice cream mix I sell in Massachusetts will be manufactured in compliance with all laws of the Commonwealth of Massachusetts pertaining thereto and all rules and regulations promulgated by the Massachusetts Department of Public Health made thereunder and will be manufactured under sanitary conditions NORTH Town Of North Andover Community Development & Services « « 27 Charles Street " ' •- `' North Andover, Massachusetts 01845 9SSACHUS�S Fax 978-688-9542 June 30, 2000 r William J. Scott Director (978) 688-9531 \ Mr. & Mrs. Timothy O'Brien Board of 710 Salem Street Appeals No. Andover, MA 01845 (978) 688-9541 Re: Sewer Tie-in Building (978) Department 45 Dear Mr. & Mrs. O'Brien: The Health Department has been supplied with a list of all residences, currently on Conservation septic, which have access to the municipal sewer system. As previously published Department (978) 688-9530 at a Public Hearing on March 17, 1994, the Board of Health has adopted regulations concerning the required sewer tie-in. The following timetable Health concerning your property status was adopted: Department (978) 688-9540 4.1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a Public Health maximum time limit of six months. Nurse (978) 688-9543 The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is Planning believed to be the most effective form of wastewater treatment. A copy of the Department entire regulation can be obtained at our office. (978) 688-9535 Any questions concerning this regulation should be directed to the Board of Health at (978) 688-9540. Additional inquiries regarding the physical tie-in and permitting process should be directed to the Department of Public Works at (978) 685-0950. Please be advised this Board intends to persevere in this regulation. Yours truly, Gayton Osgood, Chairman Francis P. MacMillan, I.D., Member Jo . Rizza, D.M.D., Member" SF/smc TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 12/9/02 SYSTEM OWNER & ADDRESS O' BRIEN 710 SALEM ST. raEO i DEC 3 0 2002 SYSTEM LOCATION (example: left front of house) EST. DATE OF PUMPING: 11/8/02 QUANTITY PUMPED -1 0 0 0 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES X NATURE OF SERVICE: ROUTINE X EMERGENCY _ OBSERVATIONS: GOOD CONDITION X FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: RAGGS SEPTIC SERVICE INC. COMMENTS: CONTENTS TRANSFERRED TO: WATER SOLUTIONS GROUP, TAUNTON TOWN OF NORTH ANDO` SYSTEM PUMPING RECO DATE: 11/15/05 SYSTEM OWNER & ADDRESS TIM O'BRIEN R Cr'1Vb NOV 15 2005 TOWN OF NOW ANDOVER HEALTH DEPARTMENT SYSTEM LOCATION (example: left front of house) 710 SALEM STREET DATE OF PUMPING: 10/27/05 QUANTITY PUMPED 1300 GALLONS CESSPOOL: NO x YES SEPTIC TANK: NO YES x NATURE OF SERVICE: ROUTINE x EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER X FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: RAGGS INC. P.O. BOX 1027 CONCORD, MA 01742 COMMENTS: CONTENTS TRANSFERRED TO: WATER SOLUTIONS GROUP, TAUNTON Commonwealth of Massachusetts Na -r4 h A redo ve r , Massachuse huo 17 NIQ &s—tem Pum pinz Record ,A I Ila so lei Siree f Date of Pumping: 6 i a y/ 1 10 Quantity Pumped: i 5 eD gallons Cesspool: No E� Yes . ❑ Septic Tank: No ❑ Yes 0 RAGGS SEPTIC SERVICE, INC. System Pumped by: d.b.a. E. A. COMEAU SEPTIC License - - Contents transferred to: WATER SOLUTIONS GROUP, TAUNTON Date ��yllCU Inspector RAGGS SEPTIC SERVICE. INC. Commonwealth of Massachusetts City/Town of NORTH ANDOVER MASSACH p System Pumping Record Form 4 JAN 06 2010 DEP has provided this form for use by local Boards of Health. T e WNt�;PAW1 rd must be submitted to the local Board of Health or other approving aut A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 7/0 5,114 w, 3;'ry-e only the tab key Address to move your Mpigh nodov it © 18 L -IS cursor - do not use the return City/Town State Zip Code key. 2. System Owner: a I 3;'r, 0'13r en Name 1�1 Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date I Zel /�C>9 2. Quantity Pumped: Gallons� 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: T " POI V, 6. System Pumped By: && L;wtoIi Name fi(' t t t fere tto /nt Com . y ;�998s Vehicle License Number 7. Location where contents were disposed: �i �chbvr�i Signature of Hauler Date hftp://www.mass.gov/dep/water/approvals/t5forms.htm#inspect .4 t5form4.doc• 06/03 System Pumping Record • Page 1 of