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Home My WebLink AboutMiscellaneous - Exception (550)� �� '/^`\ V I W �JTn� �v/ `„ v 1 `^^� 0 V J `� co M cD M Ln F F A L U S E— ru � Postage $ , IVi q C3 Certified Fee ' �Q,� Return Receipt Fee (Endorsement Required) / Q^� LJ Postmark JI0�6 tat s, t.1 J M~` C3 0" Restricted Del"ary Fee (Endorsement Required) -------� m p Total Postage &Fees $ P 5 u'1 C3 ent To!lKrc-/G%S/�j�- p-------------------------------------- � Street, Apt No.; ----`-- orPOBoxNo. /p— -------- f�! -�^, - ��K��' , City State. ZIP+----------- --- c%� :r, rr ------- --------------------- ------------------ Certified Mail Provides: ■ A mailing receipt . (69-0d) zoos eunr'0088,w,o=11 sd ■ A unique Identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Maile or Priority Mair. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. e For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized a ent. Advise the clerk or mark the mailpiece with the endorsement "Restricted -Delivery". ra If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. ■ Complete items 1, 2, and 3. Also complete A. Signat yre item 4 if Restricted Delivery is desired. X ■ Print your name and address on the reverse so that we can return the card to you. B. Received iry ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery d 1. Article Addressed to: If YES, enter ❑ Agent ❑ Addressee Printed Namd)/ I C. different from item 1?/ 11Iry address below: // ❑ 3. Servipo Type Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (rransfer from service label) 7005 0390 0003 4265 3838 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First -Class Mail.— Po,:age.& Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 TOWN OF NORTH ANDOVER O� ,10RT1� q Office of COMMUNITY DEVELOPMENT AND SERVICES �r ,•fit``° "` HEALTH DEPARTMENT - '40-0 400 OSGOOD STREET # _ — * NORTH ANDOVER, MASSACHUSETTS 01845 �'"°�,..o•%�'`c° 9SS�CHUS�� . Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX healthdept@town ofnorthandover.coin www.townofnorthandover.coni VIA CERTIFIED AND FIRST CLASS POSTAGE May 15, 2006 SJ Enterprises (Sam's Mobil) 12 Massachusetts Avenue North Andover, MA 01845 RE: Tobacco Hearing — Thursday, May 25, 2006 — Ticket #0210 (Tobacco Sales to Minors) To Whom It May Concern: On March 24, 2006, your establishment sold tobacco products to a minor working with the Healthy Communities Tobacco Control Program for routine compliance checks. This action represents a violation of Section D. Lof the Town of North Andover Board of Health's "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco." As a result of this second violation (the first violation occurred on June 22, 2005), the North Andover Board of Health has scheduled a public hearing for Thursday, May 25, 2006 at 7:00 mm. in the second floor conference room at the Town Hall building at 120 Main Street, North Andover. The purpose of this hearing will be for the Board of Health to consider action relative to the suspension of your tobacco sales permit. Per Section J.I.b. - "In the case of a second violation within 24 months of the date of the first violation, a fine of two hundred dollars ($200) and the permit shall be suspended for 7 consecutive business days. In addition, Section J.2 of the Tobacco Regulations states: "If an employee of the licensed establishment violates Section D.1, and the employer provides proof of compliance to Section #E.7 ... the Board of Health Agent may issue a fine not to exceed $50.00 to the employee who committed the tobacco sale violation. You and/or your legal counsel are hereby ORDERED to be present at this hearing in order to respond to inquiries or present evidence relative to the Board's deliberation. Failure to appear may result in an immediate suspension of your permit to sell tobacco. Please contact this office at (978) 688-9540 if you have any questions, comments or concerns. Sincere] an Y. Sawyer, REHS/RS�. Health Director cc: North Andover Board of Health Members Ron Beauregard, Director, Healthy Communities 04/24/2006 11:51 FAX 978 409 6122 HEALTHY COMMUNITIES Healthy Communities Tobacco Control Program A Boards of Health Partnership Andover Dracut Lynnfieldu MA� I Haverhill Methuen s Middleton h n FIRST CLASS POSTAGE k March 27, 2006 SJ Enterprises (Sam's Mobil) 0 u 12 Mass Ave. North Andover, MA 01845 IN"' fA 001 North Reading North Andover Reading Stoneham Topsfield Newburyport 4�, 1 1-u 7 S p eg4 11 t Re: North Andover Board of Health, Ticket # 0210 (Tobacco Sales To Minors) Attn: Manager/Owner: On March 24, 2006 your establishment was issued ticket #0210 for a second violation of North Andover Board of Health "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco," Section D.1., for selling tobacco products to a minor (the first violation occurred on June 22, 2005). As outlined on the ticket, and as explained to you upon issuance of the ticket, you have the following alternatives: 1. Elect to pay the fine ($200.00) within 21 days of the date of issuance of the ticket. 2. Elect to contest the matter in a non -criminal proceeding by making a written request within 21 days to the Lawrence District Court, Fenton Judicial Center, 2 Appleton Street, Lawrence, MA 01840. FAILURE TO PAY OR CONTEST THE FINE wITHIN 21 DAYS OF VIOLATION MAY RESULT IN ISSUANCE OF A CRIMINAL COMPLAINT. Under Massachusetts General Laws, Chapter 40, Section 2 1 D (Non -Criminal Disposition Statute), "If any person so notified to appear before the clerk or a district court fails to pay the fine provided hereunder within the time specified... the clerk shall notify the enforcing person who issued the original notice, who shall determine whether to apply for the issuance of a compliant for the violation of the appropriate ordinance, by-law, rule or regulation. " In addition to the fine assessed against the establishment, the employee who made the sale is potentially subject to a fine of $50.00 (fifty) dollars under Section J.2. of the aforementioned regulations (enclosed). If the employer wishes to produce a signed statement dated prior to the date of sale, indicating that the employee making the sale had read the enclosed regulations and state laws regarding the sale of tobacco, then said statement should be forwarded to our office and a ticket to the employee individually will be issued forthwith. All payments of fines shall be made to the Town Clerk, Town Hall, 120 Main Street, North Andover, MA 01845. If you have already made payment, thank you. Please feel free to contact me if you have any questions regarding this notice. Sincerely, Ronald N. Beauregard Program Director 20 Main Street, Andover, MA 01810 Tel: 97&749-$999 01/16/2007 09:34 FAX 978 409 6122 HEALTHY COMMUNITIES Healthy Communities Tobacco Control Program Andover Dracut Lynnfield Haverhill Methuen Topsfield FIRST CLASS POSTAGE Market Basket 350 Winthrop Ave. North Andover, MA 01845 A Boards of Health Partnership JAN 16 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT January 16, 2007 North Reading North Andover Reading Stoneham Newburyport Middleton Re: North Andover Board of Health, Ticket # 0212 (Tobacco Sales To Minors) Attn: Manager/Owner: R001 On January 12, 2007 your establishment was issued ticket #0212 for a violation of North Andover Board of Health "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco," Section D.1., for selling tobacco products to a minor. As outlined on the ticket, and as explained to you upon issuance of the ticket, you have the following alternatives: 1. Elect to pay the fine ($100.00) within 21 days of the date of issuance of the ticket. 2. Elect to contest the matter in a non -criminal proceeding by making a written request within 21 days to the Lawrence District Court, Fenton Judicial Center, 2 Appleton Street, Lawrence, MA 01840. FAILURE TO PAY OR CONTEST THE FINE WITHIN 21 DAYS OF VIOLATION MAY RESULT IN ISSUANCE OF A CRIMINAL COMPLAINT. Under Massachusetts General Laws, Chapter 40, Section 21D (Non -Criminal Disposition Statute), "If any person so notified to appear before the clerk or a district court fails to pay the fine provided hereunder within the time specified... the clerk shall notify the enforcing person who issued the original notice, who shall determine whether to apply far the issuance of a compliant for the violation of the appropriate ordinance, by-law, rule or regulation. " In addition to the fine assessed against the establishment, the employee who made the sale is potentially subject to a fine of $50.00 (fifty) dollars under Section J.2, of the aforementioned regulations (enclosed). If the employer wishes to produce a signed statement dated prior to the date of sale, indicating that the employee making the sale had read the enclosed regulations and state laws regarding the sale of tobacco, then said statement, including the name and the address of the employee, should be forwarded to our office and a ticket to the employee individually will be issued forthwith, All payments of fines shall be made to the Town Clerk, Town Hall, 120 Main Street, North Andover, MA 01845. If you have already made payment, thank you. Please feel free to contact me if you have any questions. 4onaldN. Beauregar Program Director cc: North Andover Health Dept. 20 Main Street, Andover, MA 01810 Tel: 978-749-8999 Ln 1-01 (a F-- F � [I A, L u - S [I ti Postage $ MA 0,, 01 M C:l Certified Fee M M Return Receipt Fee (Endorsement Required) VArk Here C3 Er Restricted Delivery Fee (Endorsement Required) M C3 Total Postage & Fees $ Lr) C3 Sent To C3 ............ ----------------------------------------------------- ,;i;or PO Box No. 4X /Ic 4a ------------ ------------------------------ City, SIaii,'Z"I'P-+--4 Certified Mail Provides: + + (esrenay) aooa eunr uss twos Sd ■ A mailing receipt s A unique identifier for your mailpiece ■ A record of delivery kept by the Postai Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Mail® or Priority Mail& ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. ■ For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. in For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted-Delivery". a If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt andpresent it when making an inquiry. Internet access to delivery information is not available an mail addressed to APOs and FPOs. y .w EM �IN17iEt� �7G�TES RAW POSIU SERVICE ***** WELCOME TO WARD HILL STA WARD HILL, MA 01835-9992 05/15/06 04:50PM Store USPS Trans 99 Wkstn sys5002 Cashier KBD4CW Cashier's Name LESLEY Stock Unit Id LESLEY PO Phone Number 1800-ASKUSPS USPS # 2445930630 1. First Class 0.00 Destination: 01845 Weight: 0.50 oz. Postage Type: Affixed Affix. Post.: -4.64 Total Cost: 4.64 Base Rate: 0.39 SERVICES Certified Mail 2.40 70050390000342653821 Rtn Rept (Green Card) 1.85 2. First Class 0.00 Destination: 01845 Weight: 0.50 oz. Postage Type: Affixed Affix.. Post.. -4.64 Total Cost: 4.64 Base Rate: 0.39 SERVICES Certified Mail 2.40 70050390000342653814 Rtn Recpt (Green Card) 1.85 3. First Class 0.00 Destination: 01845 Weight: 0.50 oz. Postage Type: Affixed Affix. Post.: -4.64 Total Cost: 4.64 Base Rate: 0.39 SERVICES Certified Mail 2.40 70050390000342653838 Rtn Recpt (Green Card) 1.85 Subtotal 0.00 Total 0.00 Number of Items Sold: 3 Thank' bu ' Please come again! We also accept credit and debit cards! TOWN OF NORTH ANDOVER pORTN Office of COMMUNITY DEVELOPMENT AND SERVICES 3roe'S`.o ° "` HEALTH DEPARTMENT ti s 400 OSGOOD STREET *� NORTH ANDOVER, MASSACHUSETTS 01845 4�"°��..o��''`c` 4SS�CH�SE� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX healthdeptCtownofnorthandover.com www.townofiiorthandover.coni VIA CERTIFIED AND FIRST CLASS POSTAGE May 15, 2006 Super Stop & Shop 757 Turnpike Street North Andover, MA 01845 RE: Tobacco Hearing — Thursday, May 25, 2006 — Ticket #0211 (Tobacco Sales to Minors) To Whom It May Concern: On April 21, 2006, your establishment sold tobacco products to a minor working with the Healthy Communities Tobacco Control Program for routine compliance checks. This action represents a violation of Section D. l .of the Town of North Andover Board of Health's "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco." As a result of this fourth violation (the first violation occurred on June 2, 2004, the second on August 26, 2004 and the third on August 26, 2005), the North Andover Board of Health has scheduled a public hearing for Thursday, May 25, 2006 at 7:00 p.m. in the second floor conference room at the Town Hall building at 120 Main Street, North Andover. The purpose of this hearing will be for the Board of Health to consider action relative to the suspension of your tobacco sales permit. Per Section J.I.C. - "In the case of three or more violations within a 24 month period of the date of the first offense, a fine of three hundred dollars ($300) and the permit shall be suspended for 30 consecutive business days. In addition, Section J.2 of the Tobacco Regulations states: "If an employee of the licensed establishment violates Section D.1, and the employer provides proof of compliance to Section #E.7... the Board of Health Agent may issue a fine not to exceed $50.00 to the employee who committed the tobacco sale violation. You and/or your legal counsel are hereby ORDERED to be present at this hearing in order to respond to inquiries or present evidence relative to the Board's deliberation. Failure to appear may result in an immediate suspension of your permit to sell tobacco. Please contact this office at (978) 688-9540 if you have any questions, comments or concerns. Sincerely, 'Susan . Sawyer, REHS/RS Health Director cc: North Andover Board of Health Members Ron Beauregard, Director, Healthy Communities 11/23/2011 10:23 FAX 978 409 6122 HEALTHY COMMUNITIES 2001 � o�p Healthy CommunitieS Tobacco Control Program 5L A, Boards of Health Partnership Amesbury Andover Billerica Newbury Dracut Newburyport Georgetown North Andover Groveland North Reading Haverhill Rowley lynnfield Salisbury Methuen Tewksbury Tups0eld November 23, 2011 FIRST CLASS POSTAGE Stop and Shop 757 Turnpike St, North Andover, MA 01845 Re: North Andover Board of Hcalth, Ticket # 0228 (Tobacco Sales To Minors) Attn' Manager/Owner: On November 22, 2011 your establishment was issued ticket #0228 for a violation of North Andover Board of Health regulation Section 2(a) entitled "Article X Tobacco Control Regulations" for selling tobacco products to a minor. As outlined on. the ticket, and as explained to you upon issuance of the ticket, you have the following alternatives: 1. Elect to pay the fine (100.00) within 21 days of the date of issuance of the ticket. 2. Elect to contest the matter in a non -criminal proceeding by making a written request within 21 days to the Lawrence District Court, Fenton Judicial, Center, 2 Appleton Street, 'Lawrence, MA 01840. FAMURF.. TO PAY OR CONTEST THE FINE WITHIN 21 DAYS OF VIOLATION MAY RESULT IN ISSUANCE OF A CRIMINAL COMPLAINT. Under Massachusetts General Laws, Chapter 40, Section 211)(Non-Criminal Disposition Statute), "If any person so notified to appear before the clerk or a district court fails to pay the fine provided hereunder within the time specified... the Clerk shall notify the enforcing person who issued the original notice,, who shall determine whether to apply for the issuance of a con:pliant for the violation of the appropriate ordinance, bylaw, rule or regulation, " All payments of fines shall be made to the Town Clerk, Town Hall, 120 Main Street, North Andover, MA 01.845. If you have already made payment, thank you. please feel free to contact me ifyou have any questions regarding this notice. Sit rely Ronald N. Beauregard Program Director, cc: North. Andover Health Dept. 20 Main Street, Andover, MA 01810 Tel: 978-749-8999 North Andover Health Department (ommunity Development Division June 19, 2012 Stop & Shop Supermarket Co., LLC — Store #92 Attn: Licensing Department 1385 Hancock Street Quincy, MA 02169 RE: Consideration of Request to Discontinue Tobacco Sales in Pharmacies To Whom It May Concern: This letter serves to inform you that the North Andover Board of Health recently considered an amendment of the local tobacco sales regulation. The Board's primary interest in this matter is to limit the access of under -age youths to cigarette products. A report by the US Surgeon General in March 2012 describes an epidemic of tobacco use among youth ages 12 through 17 and young adults ages 18 to 25. Tobacco use by youth and young adults leads to nicotine addiction, which can lead to severe health consequences. These effects include cardiovascular damage, reduction of lung function, and development of various cancers. One-third of youth who smoke into adulthood will die prematurely from smoking. The Board considers that the sale of tobacco is inconsistent with the mission of a health care institution, such as a pharmacy, where medical advice and services are dispensed. The Board is concerned that the prominent display and sale of tobacco products in a pharmacy, or other health care facility, sends an approving message to the public, and to the more impressionable youth, that tobacco use is really not an unhealthy activity. At the April meeting, the Board considered a regulation to prohibit the sale of tobacco products in local pharmacies. We prefer to maintain a cooperative approach to health matters and have chosen not to enact such a regulation at this time. We are asking that you consider a discontinuation of tobacco sales in your establishment, in consideration of the above points, and replace them with health promoting products. In lieu of this step, consider removing tobacco sales display from a prominent position in your counter area. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Tobacco Sales in Pharmacies June 19, 2012 If you are unable to perform the above, we ask for a reasonable explanation of your store's need to maintain the current sales display. The Board is very interested in this matter, and we ask for your written reply by July 16, 2012, after which the Board expects to consider this matter again. You may send your feedback and explanation to: bealthdept@townofnorthandover.com. If you have any questions with regard to this request, please call the Health Department directly at: 978- 688-9540, and speak with Susan Sawyer; Public Health Director. Thank you for your careful consideration of this important health issue. Sincerely, Thomas A. Trowbridge, DDS, MD Board of Health Chairman, Town of North Andover cc: File Local Store Manager Board of Health Members Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdept(aD-townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter of Transmittal Page [/" of 0"'D /6 .NO\ -� k,; [O[NI[MIWKM V 7a4AOq�TeO T0: (Q DATE: r� �✓` " O� COMPANY: FROM: Pamela Delle(hiaie, Health Department Assistant Phone: 1Z 7a&'11- / 16/D RE: Fax: �� / . �5/ / We are sending you. O Copy of Letter OPlans 0"0thertfill in below) These are transmitted as checked below: ➢ alp//p►nvedasNofed ➢ OkrApud ➢ r,4slPaqueslad ➢ OkrRwkward ➢ OlPesdvyR a*isf6r ➢ OSrske a*yiestnrd#.. REMARKS: COPY TO: COPY TO: SIGNED: COPY TO: TRANSMISSION VERIFICATION REPORT TIME 05/2312006 11:02 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 05123 11:01 FAX NO./NAME 816177207877 DURATION 00:00:43 PAGE{S} 03 RESULT OK MODE STANDARD ECM yew � _ 0'�W a% Super Stop & Shop - 757 Turnpike Street, North Andover V"dl Hearing notice was read aloud by Mr. Markey, Chairman. Maria Diaz, Store Manager was present. Ms. Diaz has been the Store Manager for approximately a month and a half. She states that it is unfortunate that a month prior to her getting the position this incident occurred. All associates who are employed by Super Stop and Shop are required to sign store policies notifying them of the rules and regulations in the store, and to agree to the stipulations in compliance with the union guidelines. The store has every single associate sign a statement that they understand all policies. Ms. Diaz stated that it is made clear to new employees how important it is to card and get identification from customers who don't look over 18 years of age. Ms. Diaz presented signed sheets from all of the associates. The young lady in question was suspended. In addition to that their government agency had to be notified. Signs were posted regarding tobacco sales. The tobacco area was moved to limit the access of associates who sell tobacco. This is a test store, and the New Hampshire stores have it as well. This arrangement limits theft and the amount of people who have access to selling tobacco. Ms. Sawyer states that the Health Department received one call about the visibility of the tobacco case being at the height of minors. However, this is a locked, separate area, and is more likely to deter sales rather than increase sales. In addition, the business agent from the union was contacted by the employee after she was suspended. Dr. Trowbridge states that he appreciates the efforts of Ms. Diaz. Dr. Trowbridge moves for the standard fine of $200 and a five (5) day suspension in light of management efforts to push for tobacco regulation compliance. Ms. Barczak seconded the motion. All were in favor. Hearing j•C,v 11121, /pl �/s' This hearing is the result of a third violation by Super Stop & Shop, 757 Turnpike Street, North Andover, MA 01845 of North Andover Board of Health "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco," Section D.1, for selling tobacco products to a minor (the first violation occurred on June 2, 2004 and the second violation occurred on August 26, 2004). Ron Beauregard appeared to present the case for above. On August 26th, Friday afternoon, at 3:10 p.m, the students entered in their ordinary fashion, emptying pockets, and attempt to buy cigarettes with no identification. Mr. Beauregard observed the student go into the establishment 5-10 minutes after, purchased Newport cigarettes for $6.29. He then met with the Manager, who was also present at the hearing. The clerk was a young adult female. A discussion ensued regarding the appropriate concern regarding the transaction. A couple of other discussions ensued regarding displays, etc. The regulations do provide for a $300 fine, and a suspension for 30 days. This afternoon, a tobacco control advisory meeting was held and attended by Susan Sawyer, and Mr. Bearuregard. The goal of Healthy Communities is to work with retailers to reduce sales. A time will be set to meet with all employees for additional training. Mr. Beauregard welcomes ideas for a reduced suspension, such as single register sales, as too many registers encourages the chances of a sale. The manager, Ms. Diaz, is advocating to move the tobacco corral at the service desk. The front end employees have been spoken to again about tobacco sales to minors. Dr. Trowbridge notes that the fine has been paid, and Mr. Beauregard suggests a 2 week suspension, rather than 30 days. Ms. Diaz states that all associates will be carding each customer purchasing cigarettes. Only a few associates will be allowed to sell tobacco products from now on. The employee who sold was terminated, and all new associates sign a form stating that if they sell tobacco to a minor they will be terminated. Motion Ms. Barczak made a motion to reduce the suspension from 30 days to 14 business days, in light of the fact that there is an active plan to reduce sales to minors within the store. The fee was paid. Dr. Trowbridge seconded the motion. Surer Ston & Shon - 757 Turnpike Street. North Andover lo,//ax/ . Hearing notice was read aloud by Mr. Markey, Chairman. Maria Diaz, Store Manager was present. Ms. Diaz has been the Store Manager for approximately a month and a half. She states that it is unfortunate that a month prior to her getting the position this incident occurred. All associates who are employed by Super Stop and Shop are required to sign store policies notifying them of the rules and regulations in the store, and to agree to the stipulations in compliance with the union guidelines. The store has every single associate sign a statement that they understand all policies. Ms. Diaz stated that it is made clear to new employees how important it is to card and get identification from customers who don't look over 18 years of age. Ms. Diaz presented signed sheets from all of the associates. The young lady in question was suspended. In addition to that their government agency had to be notified. Signs were posted regarding tobacco sales. The tobacco area was moved to limit the access of associates who sell tobacco. This is a test store, and the New Hampshire stores have it as well. This arrangement limits theft and the amount of people who have access to selling tobacco. Ms. Sawyer states that the Health Department received one call about the visibility of the tobacco case being at the height of minors. However, this is a locked, separate area, and is more likely to deter sales rather than increase sales. In addition, the business agent from the union was contacted by the employee after she was suspended. Dr. Trowbridge states that he appreciates the efforts of Ms. Diaz. Dr. Trowbridge moves for the standard fine of $200 and a five (5) day suspension in light of management efforts to push for tobacco regulation compliance. Ms. Barczak seconded the motion. All were in favor. ■ Complete items 1, 2, and 3. Also complete A. Received by (Please Print Clearly) I B. Date of Pelivery i� item 4 if Restricted Delivery is desired. ' QJ (" I '� 1 /O ■ Print your name and address on the reverse so that we can return the card to you. C. Sig lure ■ Attach this card to the back of the mailpiece, I ❑Agent or on the front if space permits. ❑ Addressee D. s delivery address different from item 1? ❑ Yes 1. Article Addressed to: If YES, enter delivery address below: ❑ No Super Stop & Shop Attn: Manager 757 Turnpike Street North Andover, MA 01845 T3. Serv' e Type Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article NuLnber (Copy iram See,.Zabel) PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952 c� UNITED STATES POSTAL SERVIC SSS- Permit N(5"10-1,0 i 10 SEP • Sender: Please print-y"8b name`, address, and ZIP+4-in this box • BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 tliliiitillitili!illiliilh itl!liliiillllilllliilliillllillilli Name (Please Print Clearly) (To be completed by mailer) Super Stop & Shop ---------------------------------------•-----•------------------------------------------------- str,�e,gpr. Turnpike Street crty,srare,z�P+a �Ior£ Andover, MA �I-$-4.5- MI u WTV 111 M. . e (1 Postage $ Certified Fee . J Postmark Return Receipt Fee � Here (Endorsement Required) � Restricted Delivery Fee —^-- (Endorsement Required) Total Postage & Fees Name (Please Print Clearly) (To be completed by mailer) Super Stop & Shop ---------------------------------------•-----•------------------------------------------------- str,�e,gpr. Turnpike Street crty,srare,z�P+a �Ior£ Andover, MA �I-$-4.5- MI u WTV 111 M. . e 986l-W-66-969zoL (GSAGAea) 66u Aler'OU96 Wlgj $d •talnbul ue Bulpw uagm ll juasoou pue #dlaaG# slgl GABS INVIMMI Ilew pue abelsod LlIM legel %U pue yoelop 'papeau lou sl ldlaoei IIeW pal p9C) ayl uo Maewlsod a 11 •bul�jewisod jol eo[4o isod eyl le alo -IlJe ayl luasaid aseald 'paalsap sl idlaoei IpIN pagpe0 eyl uo >uewlsod a 11 •„ diaAllep paloulsay„ luawasJopua eyl yl!m eoeldpew eq; �Iiew jo Talo eyl aslnpV qua6e paiuoylne s,eassaippe Jo eassaippe ayl of poloulsei eq dew dienllap 'gal Ieuolllppe ue io3 •paiinbai sl ldlaoei Ileyq pepia0 rood uo MRw;sod SdSfl a 'idlaoej wnlej eleolldnp e aol aanlem Gal a an180EU of •„palsenbaa ldlaoaa uwnlaa„ aoeldllew esaopu3 •Gel ayl aanoo of 96elsod algeolldde ppe pue elope ayl of (L L8£ wao3 Sd) idlaoaa wnlaa a yoelle pue elaldwoo aseald 'aolnaas idpo% uinlay ulelgo of •tienllap to load apinoid of pelsenbei eq dew ;dlaoea wnleU a 'Gal Ieuolllppe ue job ■ •IIeW paialsl6aa ao pamsul japlsuoo aseald 'salgenlen Jo3 •IIeW P91PP90 Wm 03(11AOHd SI 3JV83AO0 30NvunSNI ON ■ •Ilew leuolleuwalw to sselo due jol algellene lou sl IIeIM pagpoo m •IIeW dluoud Jo IIeW ssel0-lsal3 yl!m peulgwoo aq AlNO dew IIeW Pa! POO wepulway lueuodwl sjead oml jol eolnueS lelsod eyl dq 4deM dJanllep to pJooaJ V ■ AJanllap uodn amieu6ls V e aoeldllew jnod jol aa8lluepl anblun V ■ ldlam 6ulllew V m :SBPIAoad IIeW PBIIIIJ83 TOWN OF NORTH ANDOVEII Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director VIA CERTIFIED AND FIRST CLASS POSTAGE Super Stop & Shop 757 Turnpike Street North Andover, MA 01845 978.688.9540 — Phone 978.688.9542 — FAX September 7, 2004 RE: Tobacco Hearing —Thursday, September 23, 2004, 7:00 p.m., DPW Building, 384 Osgood Street, North Andover, MA 01845 To Whom It May Concern: On Thursday, August 26, 2004, your establishment sold tobacco products to a minor working with Healthy Communities Tobacco Control Program for routine compliance checks. This action represents a violation of Section D.1 of the Town of North Andover Board of Health's "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco." As a result of this second violation (the first violation had occurred on June 2, 2004), the North Andover Board of Health has scheduled a public hearing for Thursday, September 23, 2004 at 7:00 p.m. in the conference room of the North Andover Department of Public Works, located at 384 Osgood Street, North Andover. The purpose of this hearing will be for the Board of Health to consider action relative to the suspension of your tobacco sales permit. Since this is your establishment's second violation of Section D.1., your permit to sell tobacco is subject to suspension of seven (7) consecutive business days in accordance with Section J.1.b. You and/or your legal counsel are hereby ORDERED to be present at this hearing in order to respond to inquiries or present evidence relative to deliberation by the Board of Health. Failure to appear may result in an immediate suspension of your permit to sell tobacco. Please contact this office at 978.688.9540 if you have any questions, comments or concerns. Sincerely, Susan Y. Sawyer, ZIRS Public Health Director Xc: Board of Health Members Ron Beauregard, Director, Healthy Communities Tom Urbelis, Town Counsel File 08/27/2013 09:13 FAX 978 409 6122 HEALTHY COMMUNITIES 16001 •e r Healthy Communities Tobacco Control Program A Boards of Health partnership Andover North Reading Dracut eading Methuen Stoneham Middleton Tepsfleld North Andover jE1 F-IVED 1, AUG 2 7 2004 August 27, 200 TOWe 0fi l i f'WR Ni' ANDOVER Super Stop and Shop 757 Turnpike Street North Andover, MA 01845 Re: North Andover Board of Health, Ticket 9 0188 (Tobacco Sales To Minors) Attn: Manager/Owner: On August 26, 2004 your establishment was issued ticket 110188 for a violation (second offense) (tbe first offense occurred on June 2, 2004) of North Andover Board of Health "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco," Section D.1., for selling tobacco products to a minor. As outlined on the ticket, and as explained to you upon issuance of the ticket, you have the following alternatives: 1. Elect to pay the fine ($200.00) within 21 days of the date of issuance of the ticket_ 2. Elect to contest the matter in a non -criminal proceeding by making a written request within 21 days to the Lawrence District Court, Fenton Judicial Center, 2 Appleton Street, Lawrence, MA 01840. ]FAILURE TO PAY OR CONTEST THE FINE WITHIN 21 DAYS OF VIOLATION MAY RESULT IN ISSUANCE OF A CRIMINAL COMPLAINT, Linder Massachusetts General Laws, Chapter 40, Section 21D (Non -Criminal Disposition Stattne), "/jury person so nom W to appear before the clerk or a district court jells to pay the fine provided hereunder within this time speclJied...the clerk shall notify the enforcing person who issued the original notice, who shall determine whethero apply for the issaaace of a coarpliant for the violation of the appropriate ordinance, by 4aw, rale or " All payments of fines shalt be made to the Town Clerk, Town Hall, 120 Main Street, North Andover, MA 01845. If you have already made payment, thank you. Plmse feel free to contact me if you have any questions regarding this notice. cere , 5 Ronald N. Beauregar Program Director 20 Main Street, Andover, MA 01810 Tel: 978-749-8999 ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name apd address on the reverse so that we can return.the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: �S� r S�� /- -'-'g 7;-- X6 A. X ❑ Agent ❑ Addressee I B. Received by (Printed Nam' I C.Dote of I' D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. SServii Type ��Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 7003 2260 0006 8627 1046 (Transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE ' Sender: Please print your name, address, ar Health Department 400 Osgood Street North Andover, MA 01845 First -Class Mail Postage & Fees Paid USPS Permit No. G-10 Eli(Dmest►c;"Ma►IOnly 'Fotleliye_ry'i- atioi -■ L r "f/ Postmark Here m Sent To ........... i! 17�-............ ................... .. ..._..._.... wi;W, Apt. ffco or PO Box N0. �` j /i/�°I�%j9/� �✓ • -. ..............•-••• ---.....--------------------------- ------- -------- •••••- Postage $ ...0 C3 Certified Fee C3 Retum Redept Fee (Endorsement Required) Restricted Do Fee ru (Endorsement Required) � tU Total Postage & Fees L r "f/ Postmark Here m Sent To ........... i! 17�-............ ................... .. ..._..._.... wi;W, Apt. ffco or PO Box N0. �` j /i/�°I�%j9/� �✓ • -. ..............•-••• ---.....--------------------------- ------- -------- •••••- Certified Mail Provi&S: (esieney) zooz eunr'oo wJoj sd e A mailing receipt ■ A unique identifier for your m�ilpiece ■ A record of delivery kept by the Postal Service for two years �' Important Reminders: w Certified Mail may ONLY be combined with First -Class Main or Priority Mail®. w Certified Mail is not available for any class of international mail. w NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. m For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS f=orm 3811? to the article and add applicable postage to cover the fee. Endorse mailpiece 'Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required, m For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted -Delivery". w If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES �� e`,"`0 HEALTH DEPARTMENT ° 400 OSGOOD STREET +10 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director VIA CERTIFIED AND FIRST CLASS POSTAGE Super Stop & Shop 757 Turnpike Street North Andover, MA 01845 978.688.9540 — Phone 978.688.9542 — FAX healthdeptEi?townofnorthandover.com www.townofnorthandover.coni October 6, 2005 RE: Tobacco Hearing — October 27, 2005 — Ticket #0201 (Tobacco Sales to Minors To Whom It May Concern: On August 26, 2005, your establishment sold tobacco products to a minor working with Healthy Communities Tobacco Control Program for routine compliance checks. This action represents a violation of Section D.1. of the Town of North Andover Board of Health's "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco." As a result of this third violation (the first violation occurred on June 2, 2004, the second violation occurred on August 26, 2004), the North Andover Board of Health has scheduled a public hearing for Thursday, October 27, 2005 at 7:00 p.m. in the second floor conference room at the Town Hall building at 120 Main Street, North Andover. The purpose of this hearing will be for the Board of Health to consider action relative to the suspension of your tobacco sales permit. Per Section J. l .c. - "In the case of three or more violations within a 24 month period from the date of the first offense, a fine of three hundred dollars ($300) and the permit shall be suspended for 30 consecutive business days." In addition, Section J.2 of the Tobacco Regulations states: "If an employee of the licensed establishment violates Section D.1, and the employer provides proof of compliance to Section #E.7 ... the Board of Health Agent may issue a fine not to exceed $50.00 to the employee who committed the tobacco sale violation. You and/or your legal counsel are hereby ORDERED to be present at this hearing in order to respond to inquiries or present evidence relative to the Board's deliberation. Failure to appear may result in an immediate suspension of your permit to sell tobacco. Please contact this office at (978) 688-9540 if you have any questions, comments or concerns. Since 1 ' Syn Sawyer h . health Director cc: North Andover Board of Health Members Ron Beauregard, Director, Healthy Communities Tom Urbelis, Town Counsel c, /,'-"// , �� 4'es-- Hearing This hearing is the result of a third violation by Super Stop & Shop, 757 Turnpike Street, North Andover, MA 01845 of North Andover Board of Health "Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco," Section D.1, for selling tobacco products to a minor (the first violation occurred on June 2, 2004 and the second violation occurred on August 26, 2004). Ron Beauregard appeared to present the case for above. On August 26th, Friday afternoon, at 3:10 p.m, the students entered in their ordinary fashion, emptying pockets, and attempt to buy cigarettes with no identification. Mr. Beauregard observed the student go into the establishment 5-10 minutes after, purchased Newport cigarettes for $6.29. He then met with the Manager, who was also present at the hearing. The clerk was a young adult female. A discussion ensued regarding the appropriate concern regarding the transaction. A couple of other discussions ensued regarding displays, etc. The regulations do provide for a $300 fine, and a suspension for 30 days. This afternoon, a tobacco control advisory meeting was held and attended by Susan Sawyer, and Mr. Bearuregard. The goal of Healthy Communities is to work with retailers to reduce sales. A time will be set to meet with all employees for additional training. Mr. Beauregard welcomes ideas for a reduced suspension, such as single register sales, as too many registers encourages the chances of a sale. The manager, Ms. Diaz, is advocating to move the tobacco corral at the service desk. The front end employees have been spoken to again about tobacco sales to minors. Dr. Trowbridge notes that the fine has been paid, and Mr. Beauregard suggests a 2 week suspension, rather than 30 days. Ms. Diaz states that all associates will be carding each customer purchasing cigarettes. Only a few associates will be allowed to sell tobacco products from now on. The employee who sold was terminated, and all new associates sign a form stating that if they sell tobacco to a minor they will be terminated. Motion Ms. Barczak made a motion to reduce the suspension from 30 days to 14 business days, in light of the fact that there is an active plan to reduce sales to minors within the store. The fee was paid. Dr. Trowbridge seconded the motion. Cd" CIRAhold Financial Services P.O. Box 7200 Carlisle, PA 17013 October 5, 1999 Dear Controller: The purpose of this letter is to reiterate upcoming changes as a result of the implementation of Ahold Financial Services (AFS), a shared services center for transactional financial processes for all Ahold USA operating companies. This implementation begins with The Stop & Shop Supermarket Co. on October 10, 1999. The attached outlines the procedures to be followed when invoicing Stop & Shop for shipments made to stores and other authorized destinations. A matrix is provided that links the current mailing addresses to the "new" addresses for AFS. In addition, remittance procedures are included for payments that are made to Stop & Shop. Your participation in updating your systems with the new invoicing and payment addresses will ensure you continue to receive timely processing of your transactions. Please copy and distribute the attached "Invoicing & Payment Procedures" to the appropriate members of your staff. These procedures are effective for deliveries after October 10. If you have any questions or concerns with the attached, please contact AFS at (717) 960-1700. Thank you for your support through this transition. Sincerely, 124� �f --Z Brian Fields President, Ahold Financial Services Effective for deliveries after October 10, 1999 Invoicing & Payment Procedures for All Goods and Services 1. Invoicing for All Goods Delivered • Store delivery invoices must be stamped with Stop & Shop approved proof of delivery • Non -store and non -warehouse delivery invoices must be accompanied by a proof of delivery or authorization by the individual or department that received the goods • Payment may be delayed for invoices submitted without proper proof of delivery or authorization • Invoices and proof of delivery should be sent to the "new" addresses listed below • If you send correspondence to an address other than those identified below, please continue to use the current address unless otherwise advised CURRENT "NEW" (use after 10/10/99) Stop & Shop Ahold Financial Services Direct Payables Direct Payables PO Box 512 PO Box 7700 Boston, MA 02105 Carlisle, PA 17013 Stop & Shop Ahold Financial Services Warehouse Payables Warehouse Payables PO Box 993 PO Box 7600 Boston, MA 02103 Carlisle, PA 17013 Stop & Shop Warehouse Payables PO Box 1193 Boston, MA 02103 Stop & Shop Warehouse Payables PO Box 1169 Boston, MA 02103 Stop & Shop Ahold Financial Services Fixed Assets Payables Fixed Assets Payables PO Box 1280 PO Box 7800 Boston, MA 02104 Carlisle, PA 17013 Stop & Shop Ahold Financial Services Expense Payables (Inc. Utilities) Expense Payables (Inc. Utilities) PO Box 1869 PO Box 7500 Boston, MA 02105 Carlisle, PA 17013 2. Invoicing for All Services Provided • Store -service invoices require a store -stamped proof of performance • Payment may be delayed for invoices submitted without proper proof of performance • Invoices for services initiated by a purchase order should be sent to the address indicated on the purchase order, along with proof of performance • Invoices for services NOT initiated by a purchase order, should be sent to the address indicated by the individual or department that authorized your contract or service 3. Payments Due to Stop & Shop • Payments should continue to be sent to the current lockbox address • Correspondence should be sent to the appropriate "new" address listed below CURRENT "NEW" (use after 10/10/99) Stop & Shop Stop & Shop Ahold Financial Services Accounts Receivable Accounts Receivable Accounts Receivable PO Box 1942 PO Box 422 PO Box 7200 Boston, MA 02105 Boston, MA 02102 Carlisle, PA 17013 4. EDI mailbox addresses will be unaffected Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 NORTH ANDOVER BOARD OF HEALTH PROCEDURE FOR OPENING A NEW FOOD ESTABLISHMENT 1. Obtain from the Board of Health the following: a) "New" Food Establishment checklist and Plan Review packet b) Application for a Food Establishment c) Dumpster Permit Application d) Tobacco Sales Permit Application (when called for) 2. Submit scaled floor plan of establishment with particular emphasis on kitchen/food prep areas. All equipment must be identified and equipment specification sheets provided. A plan review fee of $50.00 shall accompany this submission. 3. After the floor plan has been reviewed and approved by Board of Health personnel, a Form U may be signed and construction can begin. 4. The applications to operate a food establishment, maintain a dumpster and to sell tobacco may be submitted with their associated fees at any time during this process. S. Prior to certificate of OccupancX sign -off by the Building Department, the Board of Health shall inspect the facility for agreement with the proposed plan with reference to equipment and location, finishes on walls, floors, and ceilings, lighting and any other particular items. 6. After the certificate of occupancy is signed an appointment shall be made with the Board of Health for a pre -opening inspection. This inspection must be made and the permit to operate a food establishment signed & presented to managementrp for to opening the facility. It would be appreciated if the appointment was requested at least 3 days before the targeted opening date. 13, NA nc Ar.:1TAT[! CQC IC,f-, WTTiOrINMITUITA'Mr-,N1 688-9510 T-TFAUFW 6RR-95M PT gTfT Wr, 5R8-9535 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director STOP AND SHOP PROJECT RT #114 & WILLOW STREET NORTH ANDOVER, MA REQUIRED FORMS AND PERMITS Building 1. Copy of Mass. Highway entry permit 2. Signed off Form "U" (Lot Release) 3. Peer Review Affidavit ' 4. Signed 116.0 Control Construction Affidavit 5. Copy of construction supervisor license (the supervisor must present in person) 6. Signed Workman Compensation Affidavit 7. Building Permit Application (completely filled out) a) Copy of contract to establish fee 8. Gas Permit Application 9. Plumbing Permit Application 10. Electric Permit Application 11. Mechanical Permit Application Demolition 1. Signed Workman Compensation Affidavit 2. Liability Insurance Certificate - (Hold Town Harmless) 3. Demolition of Building Affidavit 4. Signed Disposal Debris Affidavit (Legal Landfill) 5. Demolition Permit Application Miscellaneous 1. BOARD OF APPEALS 688-9541 Construction office and storage trailer permit (s) 2/4/98 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 0?02 SYSTEM OWNER & ADDRESS s Edi -," 5-1r Z,-5-7 7?O• Q�q�pvcr SYSTEM LOCATION (example: left front of house) 5•}or� �'rort r�hr fc nc DATE OF PUMPING: / QUANTITY PUMPED g000 GALLONS CESSPOOL: NO _YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE _� EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: hand:,&!zk + Sah COMMENTS: I77 CONTENTS TRANSFERRED TO: C-�arvcr TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS sy 7?D Qir�vvci- SYSTEM LOCATION (example: left front of house) �'ranf r� h t DATE OF PUMPING: QUANTITY PUMPED 9wo GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE _k:-�' EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: a a. ja -7t t man COMMENTS: CONTENTS TRANSFERRED TO: ear vcr / /Gct�MYn'f ��a11 =a i04 0 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: r/G�O SYSTEM OWNER & ADDRESS -tom 5/Ir s Z,3-7/ c/i q p� Ce c5Y- 71d• On�ovcr SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED g000 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES ✓ NATURE OF SERVICE: ROUTINE _Z EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED Rv: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) h/M12 n ---A&C4 -E- Sell% CONTENTS TRANSFERRED TO: --plavt a. 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