Loading...
HomeMy WebLinkAboutMiscellaneous - 1175 TURNPIKE STREET 4/30/2018 (7)l 1 DEP has provided this foon for use by local 59ardr, of ji9alk' Other f0m% May be usw, buy u Wormadon must be subwanwwy the same as that Prov idid local ftard of Health to determine the form they u4e ".- 60000 U64 W8 forma chezkvia, - TbeSys'4p pumping Record must be S%, ft imal Board of HeM or other approving authority within 14 *days fmm &q Pum ON aCconlance with 310 CMR 15.351. MY - Information I. SO= Location: 117S � � MAY 17S— 14yig�ve Gay/Tom 2. System Owner, WTV Addnm (d dftvrA hm location) MAY 12 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Wil' FiZZ Cayfrom -------- 13. Pumping Record - ------- 1. Date of Pumpifig 3- Dole 2. Quantity Pumped. -1- TYPO Of system: 0, COSSPOOKS) Septic Tank C) Tight Tank 01 Grease _y Q Other (deschbe). 4. Effluent Tee Filter present? 0 Yes t]DNo 5. Condition of System: -- a!- System Pumped By. Ran ea 7. Location whe4 contents were disposed: /, LS D - 6e -o fye softm of Hawn SignWe of RO*On FSC* t5ioffm.dw U06 If Yes. was N cleaned? (i yes �,.c Oft License ii�nber Sygem Fumpoinp, K5�.gpq Commonwealth of Massachusetts RECEIVED City/Town of jUL 31 2014 System Pumping Record Y p _ g LHEALTH N OF NORTH ANDOVER Form 4 DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house,_(a/ righ si f house, Left / Right side of building, Left / Right front of building, Left / Right rear uildin , Under deck City/Town 2. System Owner. State Trp Code Cityrrown State zi co Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system. ❑ ❑ Other (describe): t7 --X) �,.. 2. Quantity Pumped: v — Data Gallons —� Cesspool(s) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes Eglqo If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition otem- 6. em: 6. System Pumped By.- Nell y:Neil Bateson Name Bateson Entemnses Inc Company 7. Location -where contents were disposed: a S. Lowell Waste Water o;t VA t5fbrm4.doc• 06/03 F5821 Vehicle License Number /Y Date System Pumping Record • Page 1 of 1 t5form4.doc• 06/03 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVC® JUL .1 .1 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTM1=nr r DEP has provided this form for us& 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System LocatioRight front of house Left /Right rear of house, Left /right side of house, Left / Right side of bua�'eft / Rig ron of buildi ,Left /Right rear of building, Under deck Address City/Town l 2. System Owner: Name —Tv'Y\ Address (if different from location) Citylrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 4. State Zip Code State _ Zip Code Telephone Number Date 2• Quantity Pumped. Cesspool(s) Septic Tank ❑ Other (describe): Effluent Tee Filter present? ❑ Yes No Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 5. Condition, of stem: ���� \ 1��,✓ 6. System Pumped By: 7. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company contents were disposed: Lowell Waste M Date System Pumping Record • Page 1 of 1 3 ;�� ; e Sryy � f.l o -�• 1 tF'� R/ a .z; F pF ` r ,�ws+._�, tap.. r ...-�..�,F�fwr.�+.iy..t.a•c, '. _ a �G -RECO d achus tis t 'a t no o`wealth Q, f U4$s t, a Mfrs➢ a s rR thio :u'�x. •N:k?e..F_1 w; F - .. _ of NORTH ANDOVIRVk� Systrjf _ Cc, Emergency Routine! p t.1 CD Yes Yell 47 pcic rer Nti. C axspc �I .. No4 sty .. AtltitwpNrnpGd' gallons ! Date S\•stel. P , Pumped tby (COmpany�; 1 5< , • ;, ; Permit • Conic .is transferred 10: Coni. Its jdispostd -�.. + t Pumper SignoMfe { eve Con6tiori of systemJo�hcr cO nts� i IN F 77 01 u►Aovra NMI F �?�� 6:F, r ^ ' Commonwealth of Massachusetts = City/Town of NO. ANDOVER System Pumping Record Form 4 �M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return -key. DEP has provided this form for use by local Boards of Health. Other fora information must be substantially the same as that provided here. Before local. Board of Health to.determine the form -they use. The System Pumpi the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA 01845 City(rown State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 Cityfrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 7/1/10 Quantity Pumped: 4750 Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ YesNo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6.. System Pumped By James H. Currier Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Z/ H79 406 Vehicle License Number 7/1/10 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 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 Pumping Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ reuen -: A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON Cityrrown B. Pumping Record 1. Date of Pumping 2/3/10 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 19 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: MA State MA State Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 10044 Gallons Septic Tank ❑ Tight Tank No If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 2/3/10 Date t5form4.doc• 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER System Pumping Record Form 4 M DEP has provided this form for use by local Boards of Health. information must be substantially the same as that provided h local Board of Health to determine the form they use. The Sys the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town MA State t the a eck with your e submitted to 01845 Zip Code MA 01949 State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 0 2. Quantity Pumped: 5000 Date Gallons 3. Type of system: ❑ Cesspool(s) 9?1*'S' eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes YNo 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD --�, zl-n If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 1/10/10 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS - System Pumping Record . o Form 4. City/Town State Zip Code _ �q.i� SSZ Zlatoq Telephone Number B. Pumping Record t 6� 1. Date of Pumping Date 2. Q ntity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: -- � 2e, CP 6. System Pumped B C / -0'061 Na e Company 7. Location where conte9/Were disposed: If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number Signature ofd Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect N t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 DEP has provided this form for use by local Boards of Health. must Th Sys[-ft�Pq'� co must be submitted to the local Board of Health or other approving auth rity. 4P1. a A. Facility Information � � IV TOWN OF NORTH ANDOVER Important: HEALTH DEPARTMENT When filling out 1. System Location: forms on the computer, use only the lab key Addr ss to move your • ���. cursor - do not use the return City/TowfT State Zip Code key. 2. System Owner: Name. Address (if different from location) City/Town State Zip Code _ �q.i� SSZ Zlatoq Telephone Number B. Pumping Record t 6� 1. Date of Pumping Date 2. Q ntity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: -- � 2e, CP 6. System Pumped B C / -0'061 Na e Company 7. Location where conte9/Were disposed: If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number Signature ofd Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect N t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 City/Town B. Pumping Record 1. Date of Pumping 1/30/09 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes D/No 5. Condition of System: 6. System Pumped By. Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Hauler State Telephone Number Zip Code — 2. Quantity Pumped: 11388 talions Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 1/30/09 Date t5for n4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth. of Massachusetts �; J City/Town of NO. ANDOVER System Pumping Record msmayy ^M Form 4 OF NORTH HEALTH DEPARTMENTWN DEP has provided this form for use by local Boards of Health.but the information must be substantiallythe 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 Important: When filling out 1. System Location: forms the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. tab 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. - Address (if different from location) MIDDLETON MA 01949 City/Town B. Pumping Record 1. Date of Pumping 1/30/09 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes D/No 5. Condition of System: 6. System Pumped By. Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Hauler State Telephone Number Zip Code — 2. Quantity Pumped: 11388 talions Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 1/30/09 Date t5for n4.doc• 06/03 System Pumping Record • Page 1 of 1 Z\ Commonwealth of Mass, achRMOVED City/Town NO. ANDOVER W° System Pumping Reco d JUL 16 2009 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility information Important: When filling out 1. System Location: forms the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not City/Town State Zip Code use the return key. 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. '0f Address (if different from location) MIDDLETON MA 01949 Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 6/12/09 2. Quantity Pumped: 7256 Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Ly' No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute H79 406 Name Vehicle License Number J's Septic & Drain Company 7. Location where contents were disposed: GLSD „ A 6/12/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 ,C'N Commonwealth of Massachusetts RECEIVE® City/Town of NO. ANDOVER SEP o 8 2009 System Pumping Record Form 4 TOWN OF NORTH ANDOVER `M HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. reb 1. System Location: 1175 TURNPIKE ST. Address NO. ANDOVER MA 01845 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 8/26/09 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [1�/No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: Hauler State MA State Telephone Number Zip Code 01949 Zip Code — Quantity Pumped: 7656 2 Gallons �eptic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 8/26/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts ��� = City/Town of NO. ANDOVER System Pumping Record MAY 0 6 2009 Form 4 TOWN OF NORTH AN DEP has provided this form for use by local Boards of Health. Ot > the information must be substantially the same as that provided here. Before using this form, c ck with your focal 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 Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do. not use the return City/Town State Zip Code key. 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. �ABf s Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: 4a9/09 talons 3. Type of system: ❑ Cesspool(s) YSeptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: GOOD 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD H79 406 Vehicle License Number 4/9/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of NO. ANDOVER a System Pumping Record Form 4 'GSM Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ �easn 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 Sy be submitted to the local Board of Health or other approving authority. I RECEIVhU A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA City/Town State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record AUG 11 2009 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 01845 Zip Code MA 01949 State Zip Code Telephone Number 1. Date of Pumping 7115/09 2. Q antity Pumped Date 3. Type of system: ElCesspool(s) Septic Tank 5800 Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes UIINo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLS4/? z2 H79 406 Vehicle License Number 7/15/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER RECE� System Pumping Record APR o 7 2009 Form 4 wM TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Hea h. elfibRi d, but the information must be substantially the same as that provide ere. 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. ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name Ts Septic & Drain Company 7. Location where contents were disposed: GLSD _- ";;71 If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 3/10/09 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not City/Town State Zip Code use the return key. 2. System Owner: QB & C REALTY TRUST Name 14 GATES RD. reuen Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 3/10/09 2. Quantity Pumped: 12925 Gallons Date 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name Ts Septic & Drain Company 7. Location where contents were disposed: GLSD _- ";;71 If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 3/10/09 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts SIVE® City/Town of NO. ANDOVER o System Pumping Record JAN ` �U1q Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When -filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA City/Town State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA City/Town State B. Pumping Record 1. Date of Pumping 12/3/09 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD /� 1 Telephone Number — 2. antity Pumped Septic Tank 01845 Zip Code 01949 Zip Code 9750 Gallons ❑ Tight Tank o If yes, was it cleaned? ❑ Yes ❑ No H79 406 . Vehicle License Number 12/3/09 Date t5form4.doc- 06/03 V System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts RECEDED W City/Town of NO. ANDOVER System Pumping Record NOV 1 o.2oog w Form 4 TOWN O' F`INYttNitlrN�l/AJt ObBJf� H'tF�1L11iFN I�P�RIr°I>.'Zf Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q �enen I DEP has provided this form for use by local Boards of Health. Other forms may a use , u e 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: 1175 TURNPIKE ST. Address NO.ANDOVER MA Citylrown State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA City/Town State B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 10/21/09 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Telephone Number — 2 uantit Pum ed' 01845 Zip Code 01949 Zip Code 7063 y p Gallons Septic Tank ❑_ Tight Tank No If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/21/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of NO. ANDOVER System Pumping Record JUN - 8 2009 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other forms ni a . V4.AQ%MffgENT 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. B. Pumping Record 1. Date of Pumping 5/12/09 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes U3/No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD.n ., — 2. Quantity Pumped: 9888 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/12/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. 2. System Owner: VQ B & C REALTY TRUST Name 14 GATES RD. ted°" Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 5/12/09 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes U3/No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD.n ., — 2. Quantity Pumped: 9888 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/12/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER System Pumping Record Form 4 7M 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 Record must be submitted to the local Board of Health or other approving authority. F7WE—CE71DE Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key - Q Haan A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA DEC 0 g 2008 TOWN OF NORTH ANDOVER HEALTH DEPARThAPKIT 01845 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: H79 406 Vehicle License Number 11/11/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 City/Town State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 11/11/08 Date 2. Quantity Pumped: 11600 Gallons 3. Type of system: ❑ Cesspool(s) 2/ Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 3/No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: H79 406 Vehicle License Number 11/11/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts FHEALTH IVED f NO. ANDOVER City/Town 0 W� System Pumping Record 3 2009 Form 4 TH ANDOVER PARTME Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. r� NT DEP has provided this form for use by local Boards of Health. Other forms may a usedt 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: 1175 TURNPIKE ST. Address NO.ANDOVER MA City/Town State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA City/Town State Telephone Number B. Pumping Record 01845 Zip Code 01949 Zip Code 1. Date of Pumping 12/18/08 2. Quantity Pumped: 6688 Date Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ "71 If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 12/18/08 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of NO. ANDOVER System Pumping Record Form 4 �M 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ reran 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code B. Pumping Record ' 1. Date of Pumping 5/20/08 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD 1411 Telephone Number — 2. Quantity Pumped Septic TankS 5781 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/20/08 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts _ City/Town of NO. ANDOVER System Pumping Record Form 4 iG M 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 Record must be submitted to the local Board of Health or other approving authority. RECEIVE® Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ renes t5form4.doc• 06/03 A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/ Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 12/4/08 Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes M/No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: DEC 0 g 2008 TOWN OF NORTH ANDOVER HEALTH DEPAPTneC:1,,- MA State MA State Telephone Number — 2. Quantity Pumped eSeptic Tank 01845 Zip Code 01949 Zip Code 8982 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER System Pumping Record Form 4 'M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ renen RECEIVED AUG 11 2008 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health.het r13�%b8, _bdit the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST.. Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 Cityrr vn State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 7/16/08 4156 p g Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) VSeptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes L4' No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD , A H79 406 Vehicle License Number 7/16/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of NO. ANDOVER a System Pumping Record AUG 1 1 2008 Form 4 ' M -,fGVUN OF NORTHARI'I➢LDVER �MENT Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ HEALH DE -PART DEP has provided this form for use by local Boards of Health. Ot rms maya used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 7/29/08 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Le No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain' Company 7. Location where contents were disposed: GLSD MA State 01845 Zip Code MA 01949 State Zip Code Telephone Number —2 Qaft P d' 5156 U n 1 y umpe _ Gallons 2/septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 7/29/08 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER a System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. information must be substantially the same as that provided he DECEIVED SEP 0 8 2008 TOWN OF NORTH ANDOVER lerKbftaX/beTYW. bull Before usina this form. ch the ack 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. 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD-,, t5form4.doc• 06/03 r H79 406 Vehicle License Number 8/18/08 Date System Pumping Record . Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 8/18/08 6625 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ,® Septic Tanl�5 ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes (R No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD-,, t5form4.doc• 06/03 r H79 406 Vehicle License Number 8/18/08 Date System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER a W� System Pumping Record iG^M Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q t5form4.doc• 06/03 JUL 0 7 2008 EWN OF NORTH ANDQVER DEP has provided this form for use by local Boards of Health. �binl9rf�a beW d, ut the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record MA State MA State Telephone Number 1. Date of Pumping 6/24/08 Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Veptic TankS ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ fI 01845 Zip Code 01949 Zip Code 7875 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 6/24/08 Date System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RL- BIVBD City/Town of NO. ANDOVER FEB 1 12008 System Pumping Record Form 4 TO OV E' 9ALTO DE'T TM TER 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 Record 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 1/10/08 Date t5form4.doc• 06103 - System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST.. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return Cityrrown State Zip Code key. 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1/10/08 5750 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ElCesspool(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: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD -,, H79 406 Vehicle License Number 1/10/08 Date t5form4.doc• 06103 - System Pumping Record • Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of NO. ANDOVER System Pumping Record Form 4 M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ t5form4.doc• 06/43 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 9/24/08 Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Yo 5. Condition of System:. 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD „ A111 MA State MA State SEP 3 0 2003 HEALTH DEPARTMENT 01845 Telephone Number — 2. Quantity Pumped Septic Tank Zip Code 01949 Zip Code 10418 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 9/24/08 Date System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER v System Pumping Record Form 4 LSM 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 Record must be submitted to the local Board of Health or other aDDrovina authoritv. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ iensn " 4 A. Facility Information 1. System Location: 1175 TURNPIKE ST. MAR 10 2008 TOWN OF NORTH ANDOVER Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 2/25/08 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [a 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD „ MA State W State Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 5563 Gallons Septic Tank ❑ Tight Tank o If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 2/25/08 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 &N Commonwealth of Massachusetts City/Town of NO. ANDOVER a System Pumping Record Form 4 wM 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 Record must be submitted to the local Board of Health or other approving authority. RECEIVED A. Facility Information Important: MAY o 6 200$ When filling out 1. System Location: forms on the TOWN OF NORTH AND computer, use 1175 TURNPIKE ST. HEALTH DEPARTMENT only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not City/Town State Zip Code use the return key. 2. System Owner: reb B & C REALTY TRUST Name 14 GATES RD. 7B°P Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 4/23/08 2. uantity Pumped: 4125 Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes L7 No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Hauler H79 406 Vehicle License Number 4/23/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER W° System Pumping Record Form 4 GSM Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. teb renrn 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 Pum ' ust be submitted to the local Board of Health or other approving authority. ����'VED A. Facility Information APR. U 9 2009 1. System Location: NORTH AN 1175 TURNPIKE ST. TOHELOTH DEPARTMENT Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 3/27/08 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD — 2 Quantity Pumped: 671.8 Gallons Septic Tanks ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 3/27/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of NO. ANDOVER J System Pumping Record NOV 1 3 2008 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe)' 10/15/08 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD „ e7 — 2. Quantity Pumped Septic Tank 6406 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/15/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - not use the return City/Town State Zip Code key. 2. System Owner: r� B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe)' 10/15/08 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD „ e7 — 2. Quantity Pumped Septic Tank 6406 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/15/08 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 2 t5form4.doc• 06/03 B. Pumping Record 1. Date of Pumping 5/18/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes A No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD of — 2. Quantity Pumped: 5844 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/18/07 Date System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED T�. City/Town /Town of NO. ANDOVER Y JUN 1 1 2007 [HEALTH -'= System Pumping Record c� SVey.•"< M Form N OF NORTH ANDOVER DEPARTMENT local Boards of Health. Other forms may be used, but the a}_a3iy the same as that provided here. Before using this form, check with your local Board of Health to determine the form, "==_ -- = =- T` "_ ' - ' °- lisubmitted to the local Board of Health or other approving a. -w— np. _ A, Facility Information Important: When filling out 1. System Location: forms the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. 2. System Owner: VQ B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number t5form4.doc• 06/03 B. Pumping Record 1. Date of Pumping 5/18/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes A No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD of — 2. Quantity Pumped: 5844 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/18/07 Date System Pumping Record • Page 1 of 1 ,ryma C ,y �'.r - RECE1 �D Commonwealth of Massachusetts City/Town of NO. ANDOVER SEP 2 7 2007 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DL-FARTMENT iG M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. TfkA mam t t5form4.doc- 06/03 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the \1-/ 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: 1175 TURNPIKE ST. Address NO.ANDOVER Cityrrown 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 9/14/07 Date Cesspool(s) MA State MA State Telephone Number — 2. Quantity Pumped Septic Tank 4. Effluent Tee Filter present? ❑ Yes EZ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: 01845 Zip Code 01949 Zip Code 5875 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number System Pumping Record - Page 1 of 1 IC -N Commonwealth of Massachusetts City/Town of NO. ANDOVER System Pumping Record SEP 10 2007 Form 4 M TOWN OF NORT < DEP has provided this form for use by local Boards of Health. ®ih"'A6%� �be-fused;-but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. 1. Date of Pumping 8/3/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes X] No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSDr, 2. Quantity Pumped K Septic Tank 3031 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 8/3/07 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 8/3/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes X] No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSDr, 2. Quantity Pumped K Septic Tank 3031 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 8/3/07 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts R 'E VED City/Town of NO. ANDOVER System Pumping Record SEP 10 2007 ^M Form 4 TOWN Or' ;NORTH ANDOVER MEAL Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q ranan H DEFART�AENT ^EP h -s n-0:) idea this form for use by local Boards of Health. Other forms may e u , '.c :,substantially the same as that provided here. Before using this form, checkwith your local boars of Health to determine the form they �vY. T:.s �,�',�,.. "�... :..� "__g.' ::ws: be submitted to the local Board of Health or other approving autho.6tp. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA City/Town State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 8/24/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes a No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: 01845 Zip Code MA 01949 State Zip Code Telephone Number 2. Quan#ity Pumped: Gallons ❑ Tight Tank 4969 9 Septic Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 8/24/07 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER a wo System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. WQ �ennn Um NOV 0 5 1001 TCQIt O. _. I t•fEALI DEP has provided this form for use by local Boards of Heat . ther 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 10/19/07 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD it MA State MA State Telephone Number �2ntityPumped Septic Tank 01845 Zip Code 01949 Zip Code 4688 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/19/07 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER System Pumping Record Form 4 M DEP has provided this form for use by focal 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER cursor - do not use the return City/Town key- 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 12/11/07 Date Cesspool(s) MA State MA State Telephone Number — 2 Q antit Pum ed• 01845 Zip Code 01949 Zip Code 5656 J, p Gallons Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Leo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & brain Company 7. Location where contents were disposed: GLSD----i An H79 406 Vehicle License Number 12/11/07 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER RECEIVE® a W� System Pumping Record nM Syeyw Form 4 DEC 10 2007 DEP has provided this form for use by local Boards of Health. Other fOCNOMA�bTt tip information must be substantially the same as that provided here. B E 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 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab mean 1. System Location: 1175 TURNPIKE ST. Address NO. ANDOVER MA 01845 City/Town state Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 11/12/07 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD — ,n MA State Telephone Number 01949 Zip Code — 2. Quantity Pumped: 5250 Gallons 91 -'Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 11112/07 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 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 Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information (WO NV E Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER cursor - do not City/Town use the return key. 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code AUG - 6 2007 TCMAMI QP T ER HEALTH DEPARTMENT MA 01845 State Zip Code B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 7/11/07 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes W No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ /I Telephone Number 2. Quantity Pumped & Septic Tank 4344 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 7/11/07 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts RECEIVE® _ . City/Town of NO. ANDOVER w� System Pumping Record MAY 1 0 2007 Fora, 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Ot T T the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. OkA 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA Citylrown State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON Cityfrown B. Pumping Record 1. Date of Pumping 4/11/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD 4 -.-, - , Zz 01845 Zip Code MA 01949 State Zip Code Telephone Number — 2. Quantity Pumped: 6313 Gallons ® Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 4/11/07 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts ���� ;-A..:y._ City/Town of NO. ANDOVER J System Pumping Record MAY 1 0 2007 ` Form 4 �M T0WN OF NOR. LTH DE� Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. & EA DEP has provided this form for use by local Boards of Health. Other f 'r3y e used,but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 4/25/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes R[ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD— /7 MA State MA State Telephone Number 2. Quantity Pumped: Gallons ❑ Tight Tank 01845 Zip Code 01949 Zip Code 4563 9 Septic Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 4/25/07 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER System Pumping Record Forme 4 �M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. r� �enm R IED APR - 6 2007 TOWN OF NOF HEALTH DEFi�� 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO ANDOVER Citylrown 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON Cityrrown 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 3/28/07 Date Cesspool(s) MA State MA State Telephone Number — 2. Quantity Pumped t Septic Tank 4. Effluent Tee Filter present? ❑ Yes a No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD — 01845 Zip Code 01949 Zip Code 8431 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 3/28/07 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED W City/Town of NO. ANDOVER System Pumping Record JUN 2 5 2007 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. B. Pumping Record 1. Date of Pumping 6/13/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes K] No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD ., — 2. Quantity Pumped: 6375 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Ye93 ❑ No H79 406 Vehicle License Number 6/13/07 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return Cityrrown state Zip Code key. 2 System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 Citylrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 6/13/07 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes K] No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD ., — 2. Quantity Pumped: 6375 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Ye93 ❑ No H79 406 Vehicle License Number 6/13/07 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER W' System Pumping Record Form 4 M 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 Record must tie submitted to the local Board of Health or other approving authority. I Via= �'It, V 4=LI Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. � ieaen A. Facility Information OCT 13 2006 1. System Location: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 1175 TURNPIKE ST. Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner. 8 & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 9/23/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes (L No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD i State Telephone Number 01949 Zip Code 2. Quantity Pumped: 3375 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 9/23/06 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts RECEIVED = City/Town of NO. ANDOVER R System Pumping Record NOV i 3 2006 aForm 4 TONIN OF NORTH ANDOVER M HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. C reran A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 10/27/06 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes R1 No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD .17 MA State MA State Telephone Number — 2. Quantity Pumped Septic Tank 01845 Zip Code 01949 Zip Code 4625 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/27/06 Date t5form4.doc- 06103 System Pumping Record - Page 1 of 1 -C-\ Commonwealth of Massachusetts k9loCity/Town of NO. ANDOVER , - System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. �eaen 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 Record must be submitted to the local Board of Health or other approving authority. �77, A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA Citylrown State 2. System Owner. B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA City/Town State B. Pumping Record 1. Date of Pumping 9111/06 Date 3. Type of system: ❑ Cesspooi(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ULNo 5. Condition of System: OCT 13 2006 TOWN OF ' HEALr Telephone Number R 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 2875 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No I 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Of H79 406 Vehicle License Number 9/11/06 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 ICN- Commonwealth of Massachusetts City/Town of NO. ANDOVER System Pumping Record Fora 4 M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q DEC 14 2006 TOWN AL DEPARTM TER 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST.. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON Cityrrown B. Pumping Record 1. Date of Pumping 12/4/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): MA State MA State Telephone Number — 2. Quantity Pumped Septic Tank 4. Effluent Tee Filter present? ❑ Yes A� No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD„ n 01845 Zip Code 01949 Zip Code 3450 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 12/4/06 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 s Commonwealth of Massachusetts /72 City/Town of NO. ANDOVER RECEIVED o System Pumping Record DEC 14 2006 Form 4 G Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VC] IkA— ren TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other orf � be Obutth information must be substantially the same as that provided here. Before using this form, c ec 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: 1175 TURNPIKE ST. Address NO.ANDOVER City(rown 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: 11/17/06 Date ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes J< No 5. Condition of System. 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA State 01845 Zip Code MA 01949 State Zip Code Telephone Number — 2. Quantity Pumped: 5031 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 11/17/06 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 ` Commonwealth of Massachusetts = w City/Town of NO. ANDOVER .� System Pumping Record V Form 4 4�M 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 Record must be submitted to the local Board of Health or other approving authority. r RE C 77 7"7- Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA City/Town state 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA Cityrrown State B. Pumping Record 1. Date of Pumping 3/1/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Jjj No 5. Condition of System: G. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ Hauler MAR 0 6 2006 TOWN OF I i —1 ,{:i,� HEALTH DEPAkR l iviL= i i Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 5469 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 3/1/06 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VIC] rerren Commonwealth of Massachusetts City/Town of NO. ANDOVER F'RECIEIVE]DSystem Pumping Record 6Form 4 2TOWN OF NORTHDEP has provided this form for use by local Boards of Heal h. (Dftrrfol but the information must be substantially the same as that provide here. a orecheck 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: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 1/9/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ® No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA State MA State Telephone Number 01945 Zip Code 01949 Zip Code 2. Quantity Pumped: 3281 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 1/9/06 Date t5form4.doc• 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts RE, ffIVED City/Town of NO. ANDOVER JULY 2 2006 S stem Pum in Record y P 9 TOWN OF NORTH ANDO1iER n Form 4 HEALTH DEP,4R l TENTER 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 Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ maen A. Facility information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER MA City/Town State 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 6/9/06 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes X -No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA State Telephone Number 2. Quantity Pumped Septic Tank 01845 Zip Code 01949 Zip Code 5313 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 6/9/06 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of NO. ANDOVER JUN - 6 2006 ' System Pumping Record TOWN OF NORTH ANDOVER Form 4 Y 9 HEALTH DEPARTMENT �M 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 Record must be submitted to the local Board of Health or other approving authority. B. Pumping Record 1. Date of Pumping 5/16/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ®„ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD 12 — 2. Quantity Pumped: 5338 Gallons W Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/16/06 Date t5form4.doc- 06103 System Pumping Record - Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. 2. System Owner: CB & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 5/16/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ®„ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD 12 — 2. Quantity Pumped: 5338 Gallons W Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/16/06 Date t5form4.doc- 06103 System Pumping Record - Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab r= Commonwealth of (Massachusetts RECEIVED City/Town of NO. ANDOVER System Pumping Record AUG o 9 20 Form 4T©WN oc NORTH r.l rho 1ER Vle"ALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Ot er 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER Cityrrown 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 7127106 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 04 -No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA State MA State Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: Gallons 2844 4 R Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle license Number 7127106 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q xenon Commonwealth of Massachusetts EC EIVED City/Town of NO. ANDOVER JUL 1 2 o6 System Pumping Record TOWN OF fuCRTH ANDOVER Form 4 HEALTH DEPARTMENT 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 7/5/06 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 0_ No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Hauler MA State MA State Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 5063 Gallons W. Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 7/5106 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 o- -C-N Commonwealth of Massachusetts W City/Town of No. Andover a W° System Pumping Record iM SyO+ Form 4 DEP has provided this form for use by local Boards of Health. information must be substantially the same as that provided h local Board of Health to determine the form they use. The SyE the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key - Q re�en A. Facility information 1. System Location: 1175 Turnpike Rd. Address No. Andover City/Town 2. System Owner: B & C Realty Trust Name 14 Gates Rd. Address (if different from location) Middleton Cityrrown B. Pumping Record 1. Date of Pumping 8/12/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes R- No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD of Hauler MA State MA State NOV 2 6 2007 forms may be used, Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 4656 Gallons ® Septic Tank ❑ Tight Tank the ick with your submitted to If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 8/12/05 Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 s� N Commonwealth of Massachusetts City/Town of No. Andover System Pumping Record Form 4 M EP has provided this form for use by local Boards of He; Jtnformation must be substantially the same as that provide cal Board of Health to determine the form they use. The e local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab �ennn A. Facility Information 1. System Location: 1175 Turnpike St. Address No. Andover MA R CE V'E® JUN 0 6 2005 gotaW e , but the . rm, check with your Pumping Record must be submitted to 01845 City/Town State Zip Code 2. System Owner: B & C Realty Trust Name 14 Gates Rd. Address (if different from location) Middleton MA City/Town State B. Pumping Record 1. Date of Pumping 5/9/05 Date 3. Type of system:. ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes PS No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Telephone Number 01949 Zip Code — 2. Quantity Pumped: 3906 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/9/05 Date t5form4.doc- 06/03 System Pumping Record • Page 1 of 1 11N- Commonwealth of Massachusetts W City/Town of No. Andover System Pumping Record iGM 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 Pumping Record must be submitted to the local Board of Health or other approving authority. i B. Pumping Record 1. Date of Pumping 5/20/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes R1 No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 3386 Gallons ® Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/20/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 Turnpike St. only the tab key Address to move your No. Andover MA cursor - do not City/Town State use the return key. 2 System Owner: raa B & C Realty Trust Name 14 Gates Rd. �e Address (if different from location) Middleton MA City/Town State B. Pumping Record 1. Date of Pumping 5/20/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes R1 No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Telephone Number 01845 Zip Code 01949 Zip Code — 2. Quantity Pumped: 3386 Gallons ® Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 5/20/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 'CN Commonwealth of Massachusetts City/Town of a System Pumping Record Form 4 M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. reb RECEIVED FEB 0 7 2005 T f N O H DEPARTM TH O VER DEP has provided this form for use by local Board of Health. Other forms may be used, but the information must be substantially the same as th provided here. Before using this form, check with your local Board of Health to determine the for they se. The System Pumping Record must be submitted to the local Board of Health or other approvin aut ority. A. Facility Information 1. System Location: 1175 Turnpike St. Address No. Andover 2. System Owner: B & C Realty Trust 14 Gates Rd. Address (if different from location) Middleton City/Town MA State MA State Telephone Number B. Pumping Record 1. Date of Pumping 013105 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) ® X Septic Tank ❑ Other (describe): 01845 01949 Zip Code 1813 gal. Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes xB No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By Benjamin Shute J's Septic & Drain Company 7. Location where contents were disposed: GLSD f Hauler H79 406 Vehicle License Number 013105 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 ;r Commonwealth of Massachusetts City/Town of No. Andover ° System Pumping Record Form 4 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 3/28/05 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes ® No 5. Condition of System: 6. System Pumped By: 2. Quantity Pumped [9 Septic Tank 5800 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No Benjamin Shute H79 406 Name Vehicle License Number J's Septic & Drain Company 7. Location where contents were disposed: GLSD 3/28/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 DEP has provided this form for use by loc Boards of Health. Other forms may be used, but the information must be substantially the sa a as that provided here. Before using this form, check with your local Board of Health to determine the 2ing m they use. The System Pumping Record must be submitted to the local Board of Health or other appr authority. A. Facility Informatio Important: When filling out 1. System Location: forms on the computer, use 1175 Turnpike St. only the tab key Address to move your No. Andover MA 01845 cursor - do not use the return CitylTown State Zip Code key. 2. System Owner: B & C Realty Trust Name 14 Gates Rd. Address (if different from location) Middleton MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 3/28/05 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes ® No 5. Condition of System: 6. System Pumped By: 2. Quantity Pumped [9 Septic Tank 5800 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No Benjamin Shute H79 406 Name Vehicle License Number J's Septic & Drain Company 7. Location where contents were disposed: GLSD 3/28/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 .r Commonwealth of Massachusetts w City/Town of No. Andover o System Pumping Record Form 4 M B. Pumping, Record 1. Date of Pumping 4/5/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company T. Location where contents were disposed: GLSp.� _... — 2. Quantity Pumped: 4313 Gallons R Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 4/5/05 Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 RECE'VED MAY 0 9 2005 DEP has provided this form for use by local Boards of Health. N RTH ANDO'JER Othe $r Als�e`df tiTut t information must be substantially the same as that provided here. Is orm, 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 Important: When filling out 1. System Location: forms on the computer, use 1175 Turnpike St. X -Z only the tab key Address to move your cursor - do not No. Andover MA 01845 use the return City/Town State Zip Code key. VkA 2. System Owner: B & C Realty Trust Name 14 Gates Rd. Address (if different from location) Middleton MA 01949 City/Town State Zip Code Telephone Number B. Pumping, Record 1. Date of Pumping 4/5/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company T. Location where contents were disposed: GLSp.� _... — 2. Quantity Pumped: 4313 Gallons R Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 4/5/05 Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of No. Andover System Pumping Record w Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 2aen 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 1175 Turnpike St. Address No. Andover City/Town 2. System Owner: B & C Realty Trust Name 14 Gates Rd. Address (if different from location) Middleton City/Town B. Pumping Record 1. Date of Pumping 4/18/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes a No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD Of MA State MA State Telephone Number 2. Quantity Pumped Septic Tank 01845 Zip Code 01949 Zip Code 3781 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 4/18/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 ` Commonwealth of Massachusetts City/Town of No. Andover System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Alf Baum 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 537 Boxford St. Address No. Andover Cityrrown 2. System Owner: Terry Palisin Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 4/22/05 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes EL No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD_ MA State 01845 Zip Code State Zip Code Telephone Number 2. Quantity Pumped: RK Septic Tank 1000 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 4/22/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts W City/Town of/l�o�e� System Pumping Record Form 4 �M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. aw 1�1 RECEIVED DEP has provided this form for use by local Boards of ealth. Other forms may be used, but the information must be substantially the same as that Or ided here. Before using this form, check with your local Board of Health to determine the form they use.. he System Pumping Record must be submitted to the local Board of Health or other approving authori . A. Facility Information 1. System Location: 1175 Turnpike St. Address No. Andover Cityfrown 2. System Owner: B & C Realty Trust Name 14 Gates Rd. Address (if different from location) Middleton City/Town MA MA i eiepnone rvumoer B. Pumping Record 01-10-05' 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes X No 5. Condition of System: 6. System Pumped By Beniamin Shute Name J's Septic & Drain 7. Location where contents were disposed: GLSD of Hauler 01845 01949 3468 j s. ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 01 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of No. Andover REGLI V , m System Pumping Record AUG 2005 Form 4 °^Mbut the DEP has provided this form for use by local Boards of Health #fir check with your information must be substantially the same as that provided _'rte- .-- H § 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. B. Pumping Record 7/6/05 1. Date of Pumping Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes J4 No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain company 7. Location where contents were disposed: Of 4970 — 2. Quantity Pumped: Gallons ® Septic Tank ❑ Tight Tank if yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 7/6/05 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 A. Facility Information Important: 1. System Location: When filling out forms on the 1175 Turnpike St. computer, use only the tab key Address _ MA 0/ �f/S to move your No. Andover State Zip Code cursor - do not City/Town use the return key. 2. System Owner: r� B & C Realty Trust Name 14 Gates Rd. ream Address (if different from location) 01949 k Middleton MA State Zip Code City(rown Telephone Number B. Pumping Record 7/6/05 1. Date of Pumping Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes J4 No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain company 7. Location where contents were disposed: Of 4970 — 2. Quantity Pumped: Gallons ® Septic Tank ❑ Tight Tank if yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 7/6/05 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts ����_� City/Town of NO. ANDOVER System Pumping Record OCT � 2 ?nn5 Form 4 �M TOWN � DEP has provided this form for use by local Boards of Health. Oth rors_may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VIQ ween A. Facility information 1. System Location: 1175 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 9/16/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes U No 5. Condition of System: 6. System Pumped By: Beniamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA State MA State Telephone Number 01845 Zip Code 01949 Zip Code 2. Quantity Pumped: 3781 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 9/16/05 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts PE�EIVE® City/Town of NO. ANDOVER JAN0 9 2005 System Pumping Record TOWN NORTH AN OVER Form 4 HEALT EPARTI ANT GM 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VC] Blrerr t5form4.doc• 06/03 1. System Location: 1175 TURNPIKE ST. Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 12/14/05 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes JZ No 5. Condition of System: S. Systema Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA 01949 State Zip Code Telephone Number — 2. Quantity Pumped: 5625 Gallons 25 Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 12/14/05 Date System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts ECEi City/Town of NO. ANDOVER NOV - 9 2005 a System Pumping Record TOWNOFN Form 4 HEALTH ��4R�M�N�ER M 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 Record must be submitted to the local Board of Health or other approving authority. B. Pumping Record 1. Date of Pumping 10/29/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 9—No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD , — 2. Quantity Pumped: 4719 Gallons 9 --Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/29/05 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 1175 TURNPIKE ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor - do not use the return City/Town State Zip Code key. 2. System Owner: r B & C REALTY TRUST Name 14 GATES RD. mob"° Address (if different from location) MIDDLETON MA 01949 Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 10/29/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 9—No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD , — 2. Quantity Pumped: 4719 Gallons 9 --Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/29/05 Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts W City/Town of NO. ANDOVER a w� System Pumping Record Form 4 M 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 Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q Henan A. Facility Information 1. System Location: 1175 TURNPIKE ST. Address NO. ANDOVER MA City/Town State 2. System Owner: B & C REALTY TRUST Zip Code Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town B. Pumping Record 1. Date of Pumping 10/7/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes U4 No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD State Telephone Number Zip Code 2. Quantity Pumped: 3656 Gallons ,1 Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 10/7/05 Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts Coity/Town of NO. ANDOVER W° System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q wnsn 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 Record must be submitted to the local Board of Health or other approving authority. A. Facility information 1. System Location: 1175 TURNPIKE ST. Address NO. ANDOVER MA 01845 City/Town State Zip Code 2. System Owner: B & C REALTY TRUST Name 14 GATES RD. Address (if different from location) MIDDLETON MA 01949 City/Town State Zip Code B. Pumping Record 1. Date of Pumping 11/18/05 Date 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ®' No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD_ of Telephone Number 2. Quantity Pumped: 3125 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 11 /18/05 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachuseit�s _. Massachusetts tem Pum in g Record � � SAY 10 2C2 � t Svs ystem Owner System Location, Type: Emergency O Routine 9 Cesspool: No 91 Yes ❑ Septic Tank: No ❑ Yes Z Date of Pumping: �1 �? -p Quantity Pumped: 6, gallons q System Pumped by (Company): �� a- / );P� �„ Permit #: Contents transferred to: Contents disposed at: 6',4 Date Pumper Signatur - Condition of system/other comments: DEP APPROVED FORM - 12/07/9S FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachused -:F B0An p Ol a f Massachusetts n„ otem iPuM"ut Record ystem Location �l W3 /������e S/. A AAe r %� Type: Emergency ❑ Routine E�- Cesspool: No Yes ❑ Septic Tank: No ❑ Yes E Date of Pumping: Quantity Pumped: d gallons System Pumped by (Company): L permit #: Contents transferred to: Contents disposed at: S� L� Date Pumper Signaturq, Condition of system/other comments: DEP APPROVED FORM - 12107/93 FORM 4 - SYSTEM PUMPING RECORD ' of Meas"huseUs Massachusetts g JUL 1.5 2004 1j - - �trAR7MEN' Type: Emergency ❑ Routine E . Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: Y Lo -,Of �' Quantity Pumped: , j� � gallons System Pumped by (Company): Permit #: Contents transferred to: Contents disposed at: Date Y Pumper Si gnatur 24 Condition of system/other comments: t FORM 4 - SYSTEM P[JMPING RECORD Commonwealth of Massachusetts Massachusetts RECEIVED System Record ystem Owner I System Locafaon TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Type: Emergency ❑. Routine 9 Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: Quantity Pumped: ZLD p gallons System Pumped by (Company): r Permit #: Contents transferred to: Contents disposed at: Date Pumper Signatuw e,41 . .4-4 Condition of system/other comments: FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachuse s RECEIVED System PUMVing Record JUL 15 2004 System oCa" TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Type: Emergency ❑. Routine P� Cesspool: No Yes ❑ Septic Tank: No ❑ Yes 9 Date of Pumping: Quantity Pumped: l �,�� gallons System Pumped, by. (Company): ' Permit #: Contents transferred to: Date Pumper Signature Condition of system/other comments: DEP. APPROVED FORM - 12/07/9s Common C ?6c�'7 I— Se /y FORM 4 - SYSTEM PUMPING RECORD of Massachusetts Massachusetts RECEIVED JUL 15 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Type: Emergency ❑ Routine 9 Cesspool: No ® Yes ❑ Septic Tank: No ❑ Yes U9 Date of Pumping: -y Quantity Pumped: gallons System Pumped by (Company):�,ls`� 2Permit #: Contents transferred to: Contents disposed at: rI ID Date Pumper Signature Condition of system/other comments: DEP APPROVED FORM - 1210719S Commonwealth of F /y ' es FORM 4 - SYSTEM PUMPING RECORD Type: Emergency ❑. Routine 0 - Cesspool: No OF Yes ❑ Septic Tank: No ❑ Yes 9 Date of Pumping: �-/ Quantity Pumped: 9e) Q gallons System Pumped by (Company): / /1 Permit #: Contents transferred to: Contents disposed at: (a y 1 Dat - d Pumper Signator - Condition of system/other comments: ��i FORM 4 - SYSTEM PUM ING RECORD Commonwealth of Massachuseus vo') .0,0,9 fl... . Massachusetts. System PumXan Record Type: Emergency ❑ Routine 9 Cesspool: No ® Yes ❑ Septic Tank: No ❑ Yes N Date of Pumping: Quantity Pumped: gallons System Pumped by (Company): ' / ,, Permit #; Contents transferred to: Contents disposed at: 6�s D Date Pumper Signatur Condition of system other comments: DEP APPROVED FORM - 12/07/9S Commonwea Uh of FORM 4 - SYSTEM PUMPING RECORD v//r�rD b,YU?i1i'i rj\f=R/ . Jum - 9 6 l Yn� �e� M7� Type: Emergency ❑. Routine Cesspool: No Yes ❑ Septic Tank: No ❑ Yes 93 Date of Pumping: � 17- zo - Dy Quantity Pumped: gallons System Pumped by (Company): V C � (��,. ¢ Qf,� 44 Permit #: Contents transferred to: Contents disposed at: �ch Date/p-t Pumper Signa Condition of system/other comments: DFP APPROVED FORM - 12107/93 Commonwealth of ystem � / l��=tit ��_� ✓��. ® N � 4 - SYSTEM PUMPING RECORD achusetts I .- system Location vrr C, Type: Emergency ❑ Routine 0, Cesspool: No 9 Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: 6 Quantity Pumped: gallons System Pumped by (Company):' t<° � :2)ZA1%.1�7 Permit #: Contents transferred to: Contents disposed at: DateQ�/d-d Pumper Signatur 1 Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts , Massachusetts Type: Emergency ❑ Routine fes- . 1 SEP 10 2004 Cesspool: No Yes ❑ Septic Tank: No ❑ TG!r&0F 'TH ANDOVER �I�dLTpPA^RTMENT Date of Pumping: - Quantity Pumped: gallons System Pumped by (Company): ' ,r / Permit #E: Contents transferred to: Contents disposed at: Date - d Pumper Signature Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - SYSTEM PUWING RECORD of Massachusetts Massachusetts -;P� -- S- /- S'z- - Je Type: Emergency ❑ Routine 2- SEP 10 2004 1 Cesspool: No ® Yes ❑ Septic Tank: No REN AOL ' HRT,TeR Date of Pumping: -a / Quantity Pumped: � gallons System Pumped by (Company): - Permit #: Contents transferred to: Contents disposed at: A Date Pumper Signator ` Condition of system/other comments: DEP APPROVED FORM - W07195 FORM 4 - SYSTEM PUMPING RECORD of Massachust Massachusetts s nlllld-�4; RECEIVED SEP 10 2004 HEALTH- DEPARTMENT Type: Emergency ❑ Routine 0, Cesspool: No Yes ❑ Septic Tank: No ❑ Yes ®. Date of Pumping: ��_ Quantity Pumped: gallons System Pumped by (Company): 142z� Permit #: Contents transferred to: Contents disposed at: Date Pumper Signature n . Condition of system/other comments: DEP APPROVED FORM -12107195 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts RECE.:6' assacnusettOCT 0 6 2004 At ninz Record TOWN OF ri n System Ocat10 TH DEPARTf,4ENT Ila, /''"(,W1el"6 11, /V Type: Emergency ❑ Routine Pr - Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes ❑ Date of Pumping: 2-01 1 Quantity Pumped: 01& 6 gallons System Pumped by (Company): ' f Permit #: Contents transferred to: Contents disposed at: Date Pumper Signatur d-2, Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - SYSTEm PUMPING RECORD of Mass chuseus Massachusetts RECEIVED s � s TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Type: ]Emergency ❑. Routine B- _ Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: 9 %- d Quantity Pumped: gallons System Pumped by (Company): ' Permit #: Contents transferred to: Contents disposed at: (�14 Date �� Pumper Signatur d ,-1 Condition of system/other comments: Commonwealth FORM 4 - SYSTEM PUMPING RECORD EF ,bf Massachuse Massachusetts o w a OCT 0 6 2004 TOWALTH DEPARTMENT , ANDOVERF NORTH doVe Type: Emergency ❑. Routine R- Cesspool: No Q Yes ❑ Septic Tank: No ❑ Yes 9 Date of Pumping: 9 ?4 z Quantity Pumped: /&) ,/) gallons System Pumped by (Company): h�i� /) i„ Permit #: Contents transferred to: Contents disposed at: Date_ �d Pumper Signature ^ Condition of system/other comments: FORM 4 - SYSTM4 PUWING RECORD CommonweaUh �f Massachusetts r iYitz�7a7Q\ti lii�7ii {.4�7 ��A��� d@�® Ir Record �Q TOWN OF NORTH ANDOVER HE LTH DEP�TMENT ENT Ise_ led. Type: ]Emergency ❑. Routine 9 - Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: �?d -6x Quantity Pumped: gallons System Pumped by (Company): �G �'Permit #: Contents transferred to: Contents disposed at Date Pumper Signa p F -- Condition of system/other comments: FORM 4 - SYS'T'EM PUMPING RECORD Commonwealth o Massachusetts Massach S stem Re rd pv _ 3 2004 ysiem Owner System o7.on SN �_� L ONep100 �RTM�/��tS Type: Emergency ❑ Routine 9 - Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: Quantity Pumped: gallons System Pumped by (Company): is , v Permit #: Contents transferred to: Contents disposed at: Date /D�`. -� Pumper Signatur Condition of system/other comments: DEP APPROVM FORM- 12/07/95 FORM 4 - SYSTEM PUMPING RECORD of Massa SRFRECEIVED .awave" D".". wa NOV - 3 2004 ayS%em LOMO 1�HEALTH DEPAR-W jT- �� X U / �' °� /or 4n16✓e-r Type: ]Emergency D Routine 0 Cesspool: No 0 Yes ❑ Septic Tank: No ® Yes Date of Pumping: 1� % Quantity Pumped: gallons r System Pumped by (Company): /� ` Permit #: Contents transferred to: Contents disposed at: Dat%�Qj Pumper Si JD Condition of system/other comments: DFP APPROVFA FORM -12mos FORM 4- SYSTEM PUMPING CORD n0nWGv&h Of hU"ECEIVED r Massachusem DEC 0 8 2004 C8L1011 HEALTH DEPARTMENT Type: Emergency 11 Routine [ Cesspool: No 2 Yes El Septic Tank: No Yes �. Date of Pumping:Pumped:ped: - ,� Ballo QuantityP�/D_ tis System Pumped by (Company): _ - � _ permit W.- Contents : Contents transferred to: Contents disposed at: Date Pumper Sier Condition of systemlother coents Commonwealth Massachusetts—t� Cd � /Q/er , Massachusetts stem x� Record JAN x 3 2n,n� ystem Type_ Emergency ❑ Cesspool: No Yes ❑ Date of Pumping: Routine � Septic Tanis: No ❑ Yes Quantity Pumped: gallons System Pumped by (Company): a— Permit Contents transferred to: Contents disposed at: Date I.LL —6v Pumper Signatu 4�4� Condition of system/other comments: DEP APPROVED FORM - 12107/95 Commonwealth of System Y Gv 1/yx Type: Emergency C7 Cesspool: No F4Yes ❑ Date of Pumping: a-/ , dK C setts I JAN 13 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 7, le V " e -r, Routine 16 Septic Tank: No ❑ Yes R Quantity Pumped: _,�aZ gallons System Pumped by (Company): +_rzr Permit #: Contents transferred to: Contents disposed at: Q si Date/ Pumper Signature r Condition of system/other comments: FORM 4 - SYSTEM PUMPING RECORD 7T&Aj'�4 OF NORTH APJDV- E.k/ Commonwealth of Massachusetts a®APo_oF Hrtst.-FFia� Massachusetts MAY 10 2001 System Pumping Record- a p-- J. ,��o ✓� �1 � V e Type: Emergency ❑ Routine ` UK, Cesspool: No FA Yes ❑ Septic Tank: No ❑ Yes 0 Date of Pumping: - D Quantity Pumped: o gallons System Pumped by, (Company): 7��,F el Permit #: Contents transferred to: DatePumper Signature - Condition of system/other comments: FORM 4 - SYSTEM PUMPING RECON OF NORTH ANU,, 0OP.,9, D OF HE LT H is MAY !0vIl Commonwealth of Massachusetts Massachusetts System Pumping Record ystetn Type: Emergency ❑. Routine 9� Cesspool: No Yes ❑ Septic Tank: No ❑ . Yes Date of Pumping: �- �, Quantity Pumped: ���d U gallons System Pumped by (Company): /7 Permit #: Contents transferred to: Contents disposed at: Date Y Pumper Signatur Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - SYSZ' M, , r-II'`ING-RECORD 8OAR D OF NYS`._ Commonwealth of Massachusetts Massachusetts MAY 10 System Pumping Record System Owner System Location Type: Emergency ❑. Routine C� Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes ❑ Date of Pumping: D Quantity Pumped: % j� O gallons System Pumped by (Company): C Permit #: Contents transferred to: Contents disposed at: Date Pumper Signaturv��Z —�C� Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - Commonwealth of Massachusetts , Massachusetts System Pumping Record stem t a MAY I z Type: Emergency ❑ Routine Pf- Cesspool: No ® Yes ❑ Septic Tank: No ❑ Yes N Date of Pumping: 4/ Quantity Pumped: gallons System Pumped by (Company): /7 Permit #: Contents transferred to: Contents disposed at: Date J Y Pumper Signatur (117 Condition of system/other comments: DEP APPROVED FORM - 12/07/43 FO4—SYSME'sROOM s �mFd\Fig .r l11-01 i Type: Emergency Q Routine 19 Cesspooh No Yes Q Sgdc Tank No Yes IR Date of PumpiBX a -d Y Quanfty Pumped:- Ba4 gatlons Sym Pumped by (Company)_ f Permit #-- Contents .Contents tmsfemed to: -Contents disposed at; ( �;,.lX � �,li' � � 13731► :i _1t ,3271 " • f ft ! Y ) is T VT:%tY i�YF 1 Mf- 11111 mill. t -rte ` ®r `` Commomweafth of r assadeus Fig 13 VA Itd�eA�� Type_ Entergcncy 0 Cesspool- No 4, Yes D Regie 0 Septic Tank No Q Yes 12 Date of Pt mpiof /- - D -Quouft Puw@e&PR OW sg Pumpedby (Company): -/Z c .f / Pew . .Contents disposed at i t ! itti= 1)f ! tiY:�tf t If. 1 Mf,3t )tL�. i.11. VSB 13 20 /%4. , A7 vQ k Type: ]emergency Q Roane Vii.. Cesspool- No 0 Yes ❑ Septic Tank No El Yes Date of Pumping:- f _' Quanft Pnmped: %Q p gallons System Pumped by (Company): < < Permit Contents trms&n:ed to: -Contents disposed at Date _ - 3 - o y Pumper Sigmtm r Condition of Mother coamaents: commnweaa Z Of SYS zt � &, �4 PS,'l/k a. Type: Emergency Q Roudne R Cesspool: No Yes Septic Talc No Q Yes a Date of pumpinx -,o / QTY Pump= _ �, rO n gallons System Pumped by (Company): Permit g_ . Contenm tr n- to. :Contents disposed at Datej 2- Peer Sim Condon of system/other crommew s: t „saw' Type_ Ewi.ergency Q Routine 19 Ces-spoot No Yes Q tic Tam No 13 Yes �.. Da€c of P mph e� /I ' �, - QUOUftPowelk - moo o gauons System. Pumped by ( y)c �7- � _ a (n. pew � . FVmper MWM=44� . . .......... . . 4 7 %0� VIAIV 0 6 0 "N -,A I f 0 80 Ov y0 Type: Emergency 0 Routine 19 Cess adt No Yes Q SepficTadc No Yes F1 Dade ofP=Wiw Qpanfity Pumped: gaRons 4vst--m Pumped by (Campiny): Ao�-T //"7 Peumit .Con&sposed at Date" -f- S - PMwer ctmordion Of nhInwr ya"Aaa Type_ Emergency Q Cesspool- No Ed Yes Q .t7" • ' us s t7 'Ti 0.F of A f,1 Rome a Septic Tam No Yes El Siem Pumped by (ly)=02 i Pew . f s 7--, s, .t 7t,a, :.r: ,t 33a P co on of MIO&W comments: � Gomes ✓�-- Type: Emergency Cesspool No RI Yes '; r -) A " YAl Ronne a tic Tank No Yes 4vst= Pttnped by C YC . c ¢iect. f Pmt 9-- . (41 s : 6 .Contents digxkscd at Conte or M10 CAMMMEWCaft Of tts iflassachuse Sig& Lim ��� Recard aj=�= Type: Entergency 0 Roudne K CesspooL No El Yes SeocTadc No El Yes El Dab--ofPwnpina-- Qnan&y PmVed-- 7,J' gd[ons System Pumped by (CbMFM/., 2 Peanitg--, -7 DaW,f-)4Z-DY Pampw slo condiam of M109MW commealw- I 31 iCi ®gLtL°l r iflassadwsem PmmwL7 It iC -- - r' VVR , t '/,mss Type_ Eneigeney Q Cesspoot No M Yes Q Dam oft 2-dL -v - Rougne R c Tangy No Yes IR Systam Pumped by ( y)- -^ penaat f-, DaW aPMMFW--� Condon of MOO Commonweaun of ivlussucri-uacai,, Massachusetts Svstem P>!g Record ,System wner System ocation y __ -_ Q6_�\�o�tna= 60-AP6 Off"' H 1 H � r a Type: Emergency 0 Routine Ca' Cesspool: No 9--l", � �.,/ Yes ❑ Septic"Tank: No ElYes 9 Date of Pumping: ��%io%G3 Quantity = t mped:, - �3 )co gallons System Pumped by (Company): - Permit n: Contents transferred to: Contents disposed at: L5 -2o Date - fc �Z Pumper Signature, �- Condition of system/Other comments: DEP APPROVED FORM— IW07/9S Commonweaan of tY1u��uc«u�GLL� , Massachusetts Record M weer ystem ocation Al APR Type: -Emergency 0 Rdutine i Cesspool. No LJ Yes Septic -Tank: No Yes LJ Date of Pumping: 1� / ,' Quantity- � draped:, -z9- -00 gallons System Pumped by (Company): ' -.� _ � Permit n: Contents transferred to: .Contents disposed at: Date ?u Pumper Signature t Condition of system/other comments: DEP APPROVED FOPM- LV07195 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts ,�ystern 1�`uot�in Record 12"9" fvtU i y G pec td / l lt� Type: Emergency ❑ Cesspool: No Yes ❑ Date of Pumping: 31Im 3 - 003 � APR 92 Routine 0" Septic Tank: No ❑ Yes 2 Quantity Pumped: )(V O gallons System Pumped by (Company): Permit #: Contents transferred to: .Contents disposed at: �- -<0 Date _ ` Pumper Signatur -,1. Ce Au-,� Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts ystejn �P`urn ai�P Record 1 </1,-h C)fcfq7 Type: EK ED Cesspool: No LK Yes ❑ Date of Pumping: 63 f J6-103 l /qS- 9 Routine C?"' APR - 9 Septic Tank: No ❑ Yes Quantity Pumped: ;Z()rjp gallons System Pumped by (Company): //� , e- -f at . c,;Q Permit #: Contents transferred to: .Contents disposed at: Date Pumper Signature ��� Condition of system/other comments: DEP APPROVED FORM - 12107195 Commonweaan of 'vl assu(;r&",3 r t L-3 Massachusetts Sys Pyr znP' Record 9 2003 Type: Emergency 0 Routine Cesspool: No Yes El Septic Tank: No El Yes lam' uanti hum ed :, G' U gallons Date of Pumping: 3 /.3 �0 Q � p System Pumped by (Company): Permit: Contents transferred to: -Contents disposed at: rn L 53 Date Pumper Signature // Awe i�,�� Condition of system/other comments: J)FX _ wrrxavm roxM -iro71ps . FO4- OffjMeqof Mirsnwhmeftj rMassachusetts 6 2QQ3 Zuni WN C �ajza-S ode s r Type_ Emergency Q Routine S Cesspool_ No Yes Septic Tanta No Q 'Yes Date of Pumping _/x,10 ' D 3 - Qty Pumped: 04-G) n gallons System Pumped by (Company)_ ' d D -,Permit 9- . Contents trans to: Contcn disposed at: Date la YA - a 3 Pumper Signat= z Condifiott of sys6 mlother coram ft: A4ti/� Comwo-weakof Maswhwd& r Massaci usetts --V�C . SYS f Miaif 2003 b1slent own" i� 6-de A41.1 Type: Emergency Q Routine �- CesspooL- No 'des Q Septic Tantc No ❑ Yes Date of Pumpang Quantity Pupped: iD l) gallons System Pumped by (CompanY)= Permit . . Contents #rinska-ed to: -Contents disposed at r Date Pumper Si - Condition of sysb=/other commence Fj EU -1 3 t '60, J-� /y GaA-0-S /j, aafflim 4�� 111,417 10�966Ve-r/A4 Type: Emergency Q Rome 9- CesspooL- No W "ices Septic Tank No Yes Date of Pumping- 4 -5.Z2 -0,Z Quan&g Pw@e� _ �S—D gat%ns System Pumped by (Company): � / -t,,7Pezmit Contests turns to: Coates disposed at: Fate PcmiperS" _ i t ft}2. !�M ! � vSVii f�St ? tf 54111 gilt, of Mas. Massachusetts 1 2003 sv /y Gee S e� Type_ �E0 Routine fl Cesspool- No i 'des Septic Tank No Yes Date of Pumper a - Qty Pamped: 2 U gaUons Sv-s€zm Pumped by (SX)= Permit & - Coatenz transf=ed to: .Contents disposed at G� Pmzgw S _ - i t 1tITi / ! I If7j"KI T 7 f I tt =± 4ff 1tf.itlfl moils, CownonwwUh of Massachusdts r Massachusetts la 2' � 7j 14 i 114 5 ! 1 1 1115 T� . et'a da Type_ Emergency Q routine a Cesspool_ No Lld' Yes Q Septic Tanis No Q Yes B Date of Pumping- i"Y/o 3 Quantity Punped: "` 6o o gallons System Pumped by (Company): T Permit 9: . Contents uansf=nd to: _Contents disposed at: -CO Date PUMP= Sagnatute Condition of sy I em/other con.nuents: ._...�.�..�..s. Fc�C n iJF �iLf ! i � 1 ��P 2 5 2003 SCF � ,�cS Tape: ]Emergency Q CesspooL- No R Yes Q Date of Pumping Routhte 0 Septic Ta nic No Q Yes Qty wed: , gallons Sv-stem Pumped by (Company):' v Permit . Contents unuskn-ed to: Contents disposed at Date fie' Si - - Condition of systmWother comments: . \ V-. cFP2bO . Massachusetts y :j Il'JWeri k -K1 1. Type_ Emergency Q Cesspool_ No Yes Q Date of Pumping.- . 6 S - A Roue El Septic Tank No Q Yes LU l..3iJlJ } l3tfl! :�! �� , +. t ! Svstem Pumped by (Company): ! Permit 9--. Contents irons to: _Contents disposed at: Date Pumper Sl e+4 ~ � Condition of systmWother commence JON FORM-SYSM4NWINGRECOM of M r Massachusetts NOV 192003 y- lIl ,t Revd 1761, ehv(�r Type: Emergency ❑ Routine N( CesspooL- No Yes ❑ Septic Tank No ❑ Yes Date of PumpinX /d Quantity Pumped: �, j gallons System Pumped by (Company): t ¢ Permit 9_ _ Contents uansferred to: .Contents disposed at Date /0 2.OS pmmper Si Condi commonwealth of Manwhusci& r Massachusetts a NOV 19 2003 Svsftu Record Type: Emergency Q Cesspool:No RI Yes Q Date of Pumping,.- Id -4X,,6. %1%S- fo. %rem, � Roudne Q Septic Tangy No 0 Yes 2 QTY Ped'- _ ZQI) gallons System Pumped by (Compaay): Permit Contents transferred to: _Contents disposed at: Dam ld•.iy 4 Pumper Condition of sysmtother comments: COMMONweauh Of Massachusetts 192003 QuefAnor /vr'71 �. Type: ]Emergency 0 Routine B Cesspool: No Yes Q Septic Tante No Q Yes NJ Date of Pumping: o.Z - Quantity Pumped:- _ /��04 gallons System Pumped by (Company):' c .D - - Permit i s IA Contents transferred to: -Contents disposed at Date/� =1 e a ? Pumper Sime44" - Condition of systmWother comments: ,fir 0 Zd a Gam Z� lltdoe .4n, /d'!/1-- 19 • �jc/j� if1fIWV�E iyR• Type: Em rgency Q Routim L ' Cesspool No Ef 'des ❑ Septic Tank No El Yes Lk Date of Pumpinx 9-1,� - Qua nft Pamnped:- Z4, gallons Sysmm Pumped by (Compagy): ` Permit . Contents tamsfe=ed. to: .Contents disposed at: Date 9_ PMMPW S� . 6 ill f1" i Ali f_ i'i+i7�'II Yt ;-±y3C111t) i11, FORM 4 - SYSTEM PUMMG RECORD Commonwea&h of Mirssachwe& Massachusetts S N—Stan hfflVdmRevord Type: Emergency C1 Cesspool: No El' Yes F—I Date of Pumping q10 3 �7 ME) - Routine El" 2003 Septic Tank: -No Yes Quantity Pumped: /')G Oj::I�gallons System Pumped by (Company)=L Pen -nit 9: Contents transferred to: .Contents disposed at. - Date & /9k3 Pumper Condition of system/other comments: FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts r Massachusetts System PUmying ,record I y 6,_[,__s /2d , Type: �—Emergency ❑ Cesspool: No Yes ❑ Date of Pumping: _/.S -/d � / l %5 �I6e, SF- Ajo Q_ec 9-oc e 4t e.,, Routine p--' Septic Tank: No ❑ Yes Quantity Pumped: God gallons 1 System Pumped by (Company): ; Permit: Contents transferred to: -Contents disposed at: Date 6 / S o3 Pumper Signature �� Condition of system/other comments: DEP APPROVED FORM - P107/45 r p' JUNE 7 2003 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts r Massachusetts System RkmWinC .Record 11,15- T6(-t4z/-1= /Le. led' C /C Dn Type: Emergency ❑ Routine C Cesspool: No LY Yes ❑ Septic Tank: No ❑ Yes' Date of Pumping: __ J /if1o3 Quantity Pumped: G,c gallons System Pumped by (Company): �j� 7 Permit 9: Contents transferred to: .Contents disposed at: L s ,� Date / '/oma Pumper Signaturea�, Condition of system/other comments: iiDFP APPROVED FORM-1NO7/95 FORM 4 - SYSTEM PUMPING RECORD Commonwealth ©f Massachusetts r Massachusetts SYstem ua E Record Type: Emergency ❑ ][routine L" Cesspool: No ❑� ' Yes ❑ Septic Tank: No ❑ Yes Q' Date of Pumping: I0, Quantity Pumped: /J-0 0 gallons System Pumped by (Company): ` - , Permit: Contents transferred to: .Contents disposed at: Date ' Pumper Signa44 Condition of system/other comments: DFP APPROVED FORM - UW195 JUN 1 7 2003 FORM 4 - SYSTEM SING RECORD Commonweal, o, f Masswhwe& r Massachusetts i tem AMP&E Record ),)0 Type= Emergency Q Routine B ---- Cesspool: No Yes ❑ Septic Tank: No Q Yes ©� Date of Pumping:i f % iii < Quantity Pumped-- dons System Pumped by (Company): ` Permit 9:. Contents transferred to: Contents disposed at: Date Pmmper Signature Condition of system/other comment's: o"". _ • • `'C�� Tai JUN 1 72003 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts System ftmnitz.g.. .record Type: Emergency ❑ Routine DETH A �_ HD ( I PINY °' Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: 3 Quantity Pumped: �Oo & gallons System Pumped by (Company): Contents transferred to: .Contents disposed at: 6 -z --SJ Date = Pumper Signature Condition of system/other comments: DFP APPROVED FORM - 12/07/95 Permit #: FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts �ste�n `urn Record Type: E mergency ❑ Cesspool: No Yes ❑ Date of Pumping: _ i{13/03 / / 75— T(_z. x1Pt/Ce. �4tA 0� z Routine K3"" Septic Tank: No ❑ Yes ❑� Quantity Pumped: /D00 gallons System Pumped by (Company): iJ Permit #: Contents transferred to: -Contents disposed at: SZ) - Date y Pumper Signature_QU,� Condition of system/other comments: DEP APPROVED FORM - 12/07/95 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts S ystem Pumping Record y (oQkes ed, ft l d c(l�6si, 1 a - Type: Emergency ❑ Routine ❑' Cesspool: No LJ Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: 3�a y/off Quantity Pumped: d G o 0 gallons i System Pumped by (Company):_ Permit: Contents transferred to: .Contents disposed at: Date 16.3 Pumper Signature, Condition of system/other comments: FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts r Massachusetts System PumpingRecord .�ci=` fit_ • - X003 °, Type: Emergency ❑ Routine Cesspool: No Yes ❑ Septic Tank: No ❑ Yes^�'`� Date of Pumping: hl Quantity Quantity Pumped: � Dov gallons System Pumped by (Company): y ��..._,� Permit 9: Contents transferred to: .Contents disposed at: G/__5, J/ Date Pumper Signature Condition of system/other comments: DEP APPROVED FORM - 12/07/95 Commonwealm of massuc t"acGtL 1 Massachusetts S temp� pjinD, Record weer ystern ocation Poe /22" l �1 � / t/ C'o" le 6L - /)J/ %�,rw, M&, Type: Emergency 0-Rdutine 01" No Yes T ❑ Septic "Tank: No ElYes Cesspool: � . . p 0C) v eallons Date of Pumping: Quantity --Pumped:, - T System Pumped by (Company): - Permit Contents transferred to: .Contents disposed at: ro Date_ Pumper Signature -- Condition of system/Other comments: $EP APPROVED FORM -1'2107195 r Ttl Commonweaan of lYlujysucfIu0$GL-I.L Massachusetts stem l,piing Record fJ c is y 1j-/ k ri u AAR 2 8 2003 41" - Type: Emergency [I R utine Cesspool: No �A Yes ❑ Septic *Tank: No ❑ Yes � �y,� Quantity= Nrnped:,_� O gallons Date of Pumping: � � � _ s . System Pumped by (Company): t Permit -: Contents transferred to: -Contents disposed at: L 5� Date� " -' Pumper Signature Condition of system/other comments: DEP APPRO BD Foxni - irovss Commonweatrn of tvlussu(;r&uaGLt.3 Massachusetts S tem P�ping R system ocauon ; �,i- ; Y1j-v ,` x es = wner ),b- MAR 2 g 20( Puriae C�K i 171 �-' Z.z�- Type: Emergency a R utine C1� Septic ❑ S Yes ep'.Tank: No El Yes ❑� Cesspool: No � _ . uanti -Nm ed:, L -�/�OC� gallons Date of Pumping: Q p System Pumped by (Company): j - - Permit n: Contents transferred to: .Contents disposed at: Date Pumper Signatur� Condition of system/other comments: DEP APPROVED FORM - LIJ0719S Commonwealm of jv1uysuci&uac:,,,y,3 k's I?c-/ , Massachusetts Soemm Pamnin Record MAR2003 2 8 . system l.wauv„ 11175- 74-6Ui'�) / Le A,6, ( ii d o rAe,, , A Type: Emergency 0 Rdutine r-11-11 septic'. -Tank:-❑ No E] Yes Cesspool: No VJ Yes Date of Pumping: Quantity -Nmped:, / 6100 gallons System Pumped by (Company): Permit Contents transferred to: -Contents disposed at: jL s J Date jA /o 3 Pumper Signature, t J?,� t Condition of systenntother comments: DEP APPROVED FORAS - LIJ0719S FOW 4 - SYSTEM PUNVING RECORD Commonwealth of Massachusetts ; WAii'D OF��---�— -- Massachusetts FEB I I M rncord ystem vwner �I a Type; "Emergency D Cesspool: Yes Date of Pumping: �„�...._... ystem Location �1 Routine S(,ptie Tank: - = - No .� Yes ... Quantic?, Pumped: ° c?,U)O gallons System Pumped by ((;ompany}: 0c Permit Contents transferred to: Contents disposed at; Date' U Pumper Signature a'l- ..• Condition of sys;em/other.comments: DO AMOY= rcRn IZOO7111 M ( AND9i" A/ BOARD OF ` HEALTH D T 2002 FORM 4 - SYSTEM Pt,lN ING RECORD Commonwealth of Massachusetts Massachusetts system ,get. ystcm Uwner • Chis C��/ (Co- hS Type: " Emergency Q cesspool! -leo 0, -Ye-3 0 Date of Pumping: '? /6/671,0 ..... a w jov,zk; Ute cu Routine D" S(,ptie Tank: No0 Yes . �. Quantir% Pumped: -0 gallons System Pumped by (company); 0. Permit r Contents transferred to: Contents disposed at: pace' c oz Pumper Signature Condition of sys;em/other comments: DO APPROYM M&M • WOVIi FORM4 - SYSTEM PCJWING RECORD OF H§:A 5 �ommonwealth of Massachusetts Massachusetts z Becord ystern Owner —� -•- -- -- 6rQt 4�s 12d, 0 /7doZ-ol 17(a- . G - I fita Type: Emergency Cl' Routine Cesspool: No Yes D Stptic Tank: - = No C3 Yes Date of Pumping: ,, _57/ 02? o.(...�. Quantity Pumped: doo golIons System Pumped by (company): L r Permit Contents transferred to: Contents disposed at: I- .S --6 para o _ Pumper SignaturAk Condition of syslemlother .comments: UP AMOY= T1070 • ►howls FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts C ote .sm rn Xie ©rd ystCFn Uwner Type; EmergencY Cesspool: -NO 0- Yes fl Date of Pumping: 0 Routine rn LOca"91, rpm St.ptic Tank: - No a Yes r� Quantino Pumped: G o gallons System Pumped by ((;ompany): Permit Contents transferred to: Cantents disposed at: �Gs� pate va Pumper Signature' Condition of sysjem/Other comments: UP AOPAOVW MY6M • WOVIIti ystem Owner FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts System Pumping Record ystem Location Type: Emergency ❑ Routine ED -- Cesspool: No Yes ❑ Septic Tank: - - No ❑ Yes Date of Pumping: Quantity -Pumped:,, -?-.0-o 0 gallons System Pumped by (Company): 0 o 6 ` a Permit r: Contents transferred to: .Contents disposed at: �Sr Date Pumper Signature ,? ,x Condition of system/other comments: DEP APPROVED FORM - 12/07195 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts System Pumping Record Owner )6 �- Iq tion Type: Emergency ❑ Routine Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: /o W__ Quantity. -Pumped: 6 Ocy gallons System Pumped by (Company): rPermit n: Contents transferred to: Contents disposed at: Date Pumper Signatur /9��UcLiT Condition of system/other comments: DEP APPROVED FORM - 12107/95 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of ,Massachusetts Massachusetts System Pumping Record ystern 0,Amer 14 6c. 4.4 to d, ern Location 75- rut-Xptke- c-,kdow, ; Axe - Type: Emergency ❑ Routine Cesspool: No Yes ❑ Septic Tank: - -No ❑ Yes 2 Date of Pumping: Quantity-Pumped:;:2lsvc) gallons System Pumped by (Company): ' 74� 4 Permit F: Contents transferred to: .Contents disposed at: G L s� DatePumper Signature ,.x,, ,q, Condition of system/other comments: DEP APPROVED FOR'+t - 12/07/95 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record System Owner System Location Tr oRf,'111ty Tr,"rlL: R,:"31j.ty TrE!,'O: 1175 Tuunpdc.t, Turnpike S -L. Ayith Anduvor MA 0 1. 8 4orth Awipwir MA 0 1 A 4 S i736�tEi.s6? ;c +6,13a 3 Roati.ty Trilst Type: Emergency Routine Cesspool: No Yes Date of Pumping: System Pumped By: Wind River Environmental, LLC Contents transferred to: Contents Disposed at: Date. Pumper Signature: lCondition of System/Other Comments Dep Approved from - 12107195 Septic tonic: W Ye - E� Quantity Pumped: ZSOb "Ions Permit #: 6,)- 0 FORM 4 • SYS'1"�ivi PUWING RECORD Commonwealth of Massachusetts Massachusetts Sys t m * e� ystem weer y em LOW= (04f�S led• A cia7.�j � (h1d&(el�lk, � orsey� Tvpe: '' Emergency 0 Routine [� Q Sqtic Tank-. No C3 Yes r` Cesspool: -No � � Yes Date of Pumping:_�._r Quantity Pumped:Q gallons System Pumped by (gompany): ') , Permit r Contents transferred to: Contents disposed at: C�GsA — -- Dace'_�l o Pumper Signature L Condition of syslern/other .comments: �6T A9PROYEp FpR,�t • iliv7ns FORM 4 • SYSTEM PUWING RECORD Commonwealth of Massachusetts Massachusetts Aford ystem vwnc' 4 le q -4'Gee ; Type: Emergency Cesspooi: No 13 Yes 0 lon D' Routine C9-' Dace of Pumping: Septic Tank: - = - No 0 Yes Quantiny Pumped: mod Salons Permit r S\•stem Pumped by (company): Contents transferred to: Contents disposed at: Dace y�soz Pumper Condition of syslern/other .comments: QCP A"ROYEa TWO • Il/YNti Commonwealth of Massachusetts Massachusetts System mying Record System Location 1& 9" jy . (��%a/�Zcp . Type: Emergency Cesspool: No Er, Yes ❑ Date of Pumping: 4LT�, Routine Septic Tank: No ❑ Yes Quantity -Pumped:, L bc6 gallons - Permit Tr: System Pumped by (Company): t �w Contents transferred to: .Contents disposed at: G,CS-t) Date _� ,Pumper. Signature , Condition of system/other comments: DEP ArrROVED FOFhs -12107195 Commonwealth of Massachusetts , Massachusetts System Pr�m,�ning Record mer System Location fk_eL . Type: Emergency 0 Routine Septic "Tank: No ❑ Yes ❑ Se Cesspool: No 0 Yes p Date of Pumping:`If t � �o z Quantity= -P mped:, j&G_Q eallons System Pumped by (Company): r Permit n: Contents transferred to: .Contents disposed at: Date Pumper Signature Condition of system/other comments: nsr wrrROVW FORM - 11-1o7ros ystem Uwner FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts , Massachusetts System Pumping Record' ystem Location Type: Emergency ❑ Rdutine Cesspool: No Yes ❑ Septic Tank: No ❑ Date of Pumping: �,�� 7/O Z— Quantity -Pumped- , -2- 0,06 Yes System Pumped by (Company): c��,� r� Permit -4': Contents transferred to: .Contents disposed at: Date Pumper Signature . ,a ,_ 0011h,T� Condition of system/other comments: ner APPROVED FORAS - 12/07195 gallons Commonwealth of Massachusetts Massachusetts System _&Wing Record Go_ies A?oad/ TGANN OF WORTH A, BOARD OF W:il Type: Emergency 0 Robtine 0"' . - - E� Cesspool: No ET -Yes 0 Septic' Tank: No ❑ Yes I �10 Z� _�.Pd . mped:, .. 'K gallons Date of Pumping: Quantity System Pumped by (Company) Permit -rr: Contents transferred to: Contents disposed at: �OLsi) Date /6' /I _I/ 0 1.11 Pumper Signaturej�L&�-- . Condition of system/other comments: DEP APPROVED FORM - 1210719S FORM 4 - OF HEALTH Commonwealth of Massachusetts,i CW 2 Massachusetts I System Pumping Record ystem Uwner system ocation sfcet,�/a"Ale—J4 J Type:EK ❑ Cesspool: No LTJ Yes ❑ Date of Pumping: Routine 9' Septic Tank: No ❑ Yes QuantityPu'mped- 4Cnd gallons System Pumped by (Company): '3�e7�e A Permit: Contents transferred to: .Contents disposed at: Date 161106& Pumper Signature 6,- Condition of system/other comments: o�v DEP.kPPROVED FORA! - 12/07/95 Commonwealm of , Massachusetts tem min Record mner ystem ocanon q 6 0)/ ,/d lef r� �F �H A&I.,, - HEA,I Type: Emergency ❑ R utine C SEG 1 6 20 �,,..---- Cesspool: No Yes El Septic'. Yes Septic Tank: No l Date of Pumping: ��'�/oma Quantity= -Pumped:, /S 64 gal -tons ----� System Pumped by (Company): ✓� Al �-f a Permit ff: Contents transferred to: -Contents disposed at: S� Date L Pumper Signature Condition of system/other comments: DEP APPROVED FORbl-1210719S Commonwealtn of !v1[lJ,uctawaG�L� , Massachusetts ,Stern Pumpi_n Record 0�c���� �y Gc4?A Type: Emergency El RO-Utine Cesspool: No Yes ❑ Septic Tank: No ❑ Yes LJ Date of Pumping: l l /a Alla Quantity- Limped:, > )Z D ealions System Pumped by (Company): Permit n: Contents transferred to: -Contents disposed at: GSA Datet / .2 y ate- Pumper Signature � -, Condition of systenVother comments: pEP APPROVED FORAi - W1 07l9S FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts System Pumping Record ystem Owner System Location L c�ctL3- J w Type: E O Emergency Cesspool: No LTJ/Yes ❑ Date of Pumping: '7 7loa, Routine Septic Tank: No ❑ NORr Yes ❑� Quantity-Piimped: �Oo U Gallons System Pumped by (Company): a Permit: Contents transferred to: Contents disposed at: 69 L Date i/oma Pumper Signature Le, �2c�it�i.vl� Condition of system/other comments: AEP APPROVED FORAi - 12/07/95 Commonweatrn oi Tn OF 111' 'Ac.s. Massachusetts •SYrd MAR 28 � stem P�•�p�n� Record � 0 System ocaUon er rr /mss �'u�, F i l /t �S T_ r�;:� r Type; Emergency Cl R utiine Cesspool: No Yes ❑ Septic 'Tank: No ElYes U Date of Pumping: IaI a 7lo a Quantity=�'umped:,: I G)0 �� eallons System Pumped by (Company): .� '� a.� ti Permit �: FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts , Massachusetts System Pumping Record caner 6 C ,y m ocation Type: Emergency 0 koutine ❑ Cesspool: No LJ Yes ❑ Septic Tank: No ❑ Yes ❑'" Date of Pumping: x130/02 Quantity-Pdrnped., /' Clo gallons System Pumped by (Company): Permit n: 1% 7� Contents transferred to: .Contents disposed at: Date Pumper Signature A c, Condition of system/other comments: . WDEP AMOVEn FOPW - 12r07195 FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts System Pumping Record n uwner y 6q-4ez k6c Type: Emergency Cesspool: No [3, Yes ❑ m ocation ❑ Routine Septic Tank: No ❑ Yes Date of Pumping: 1Co%Z Quantity.',Pumped: gallons System Pumped by (Company): --t- Permit: Contents transferred to: Contents disposed at: Date Pumper Signature /- ' &<U7 �A Condition of system/other comments: �a nsr AMOVEn FORAi - 12/07/95 FORM 4 - SYSTEMMP PUMPING RECORD Commonwealth of Massachusetts Massachusetts t M brtz tag .record ystem 3 ee X_t� Co a t�, led - r ystCm LOaeuvn S� / 17 6— / "-'I- x,)h c Kms-- - 0 . CCU- Cf- ,,,, txC T��pe; Emergency G Routine Cesspool: -No ! Yes ❑ S(.ptic Tank: - = No ❑ Yes Date of Pumping: Quantity, Pumped: i �J-t gal;ons System Pumped by (gompany): Permit � : Contents transferred to: Contents disposed at: srj — 0,;te _ � Pumper Signature Condition of syslem/other.comments: 90 APPROVED IVA %S - tP97/11 Commonweatxn of Ivlus�uc;r�w�G Massachusetts �v tern 1Drsmuing Record Lem weer tem ocation Type_ Emergency D Rdutine Cy' Septic ❑ Se Tank: No ❑ Yes Cesspool: No � Yes P Date of Pumping: /1% /0 0, Quantity--i'umped�y gallons System Pumped by (Company): /� �-� u �� Permit n: Contents transferred to: -Contents disposed at: Q L S .� Date _/f/i/0,2, Pumper Signatur a Condition of system/other comments: DEp ArrROVED FORhI - LI07195 ys FARM 4 - SYSTEM PUNVI?�G RECORD Commonwealth o, f Massachusetts Massachusetts I fUtjP'Ke lee( X)o, Qylt%t L /VO, c A( coovet /X Type; 0 --'Emergency Q' Routine � Yes Septic Tank: = No C]Yes Cesspool: -No a Date of Pumping: A4& oma- _ Quantity Pumped: �_z��-� gallons System Pumped by (�;ampany): Permit r: Contents transferred to: Contents disposed at: S � Date _/ Pumper Signature Condition of syslem/other comments: sU APPROYM TVAPM • IVVIItf Commonwealth of Massaehusetss : Massachusetts System Pumping Record - uvin�— .>ws vi�..ou .,ro a>o rioavX ous xur.. System Owner ISystem Location APIC BUS CO. 1175 TURNPIKE STREET NORTH ANDOVER, MA 01845 (978) 686-0383 Type: Emergency Routine Cesspool: NoYes Date of Pumping: Z I / i' n System Pumped By: Wind River Environmental, LLC Contents transferred to: Contorts Disposed at: C S Date: / I /or condition of System/Other Continents Pumper Signature: Form 4 -- System Pumping�;Record E _ ABC Bus 1175 TURNPIKE STREET North Andover, MA 01845 (978) 686-0383 Dep Approved from - 12/07/95 Septic tank: w Yes [� Quantity Pumped: 0 5;0 (_> Gallons Permit #: System Owner W Taus (M WN :tiNMTtUs LT ItUPTH ANEA::6 ER MA 01345-40,)5 1375} 685-03.! Type: Emergency Cesspool: Klo Date of Pumping: (, System Pumped By: Contents transferred to: Contents Disposed at: Date: Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumoina Record Routine Yes Wind River Environmental, LLC of System/Other Comments Pumper Signature: System Location HEC Buz, 1175 71."FMPfKE :` T`r?l;E1 North Andover, !SA C-Io45 t47oi A66-0383 Dep Approved from 4C 2107/95 JUL a 3 2001 L----- - Septic tank: Klo Yes []D--' Qua" Pumped: 6allons Permit #: System owner ABC BUS CO. 1175 TURNPIKE ST NORTH ANDOVER, MA 01845-6155 (978) 686-0383 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record item Location ABC Bus 1175 TURNPIKE STREET North Andover, MA 01845 (978) 686-083 t Type: Emergency Routine Cesspool: No Yes Septic tank: No Yes Date of Pumping: - �.- / Quantity Pumped: lion System Pumped By: Wind River Environmental, LLC Permit #: Contents transferred to: r. Contents Disposed at: Sib L R V� �;/0/00� Date: Pumper Signature: Condition of System/Other Comments Dep Approved From - 12/07/95 System Owner . AEC EUS C-0 117s TURIVIKE ST tNArl'i-1 AhT70 P.F.. MA 01895-6155 (9,78) 68F •038 Type: Emergency Cesspool: (vo Commonwealth of Massachusetss : Massachusetts System Pumping Record Routine Yes Date of Pumping: (o�I O System Pumped By: Wind River Envlronmentoi, LLC Contents transferred to: Contents Disposed at: (,(S( Form 4 -- System Pumping Record System Location ABL' Bus' 1175 TIRINPIKE :-M-EFT North Anduvor. KA 0.1895 ,(97aj e86-0303 Septic tank: w =Yes Ei—' Quantity Pumped: gStm Gallons Permit #: 11A� l `lUi Y 15 200fp Approved from - 12/07/95 �C/f i 'f Form 4 -- System Pumping Record Commonwealth of Mossachusetss : Massachusetts System Pumping Record --van Unll ,"rxvit-M JUrilu -YeL®Ili, lanK k6 nlull ltivt)l. aJvv qas System Owner System Location ABC BUS CJD ABC Bus 1175 TURNPIKE ST '1175 TURNPIKE STREET NORTH ANDOVER, MA 01845-6155 North Andover. 1AA 01845 (978) 686-0383 (976) 686-0383 Type: Emergency Routine Cesspool: W Yes Septic tank: No Yes Date of Pumping: (l , �) J Quantity Pumped: —( ffp lens T r System Pumped By: Wind River Enwronm eal, LLC Permit #: Contents transferred to: Contents Disposed at: C3 - Date: Pumper Signature: Condition of System/Other Comments Dep Approved From - 12/07/95 �i'w N OF NORT3 1 J" 6OAPD OF r. awt3JlN ` 7 20a� i d Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record ABC BUS CO. 1175 TURNPIKE ST NORTH ANDOVER, MA 01845-6155 (978) 686-0383 Type: Emergency Routine Cesspool: Pio _/ Yes Date of Pumping: System Pumped By: Contents transferred to: Contents Disposed at: Date: Wind Neer Environmental, LLC of System/Other Comments Pumper Signature: Location ABC Bus 1175 TURNPIKE STREET North Andover, MA 01845 (978) 686-0383 G -L S1� r Septic tank: Mo =Yes Quantity Pumped: % 5�0aallons Permit #: �TOVVNOFNOFdiHX,10 3'rri ri/ BOARD OF HF TH JUN 12 2001 Dep Approved from - 12/07/95 Commonwealth of Massachusetss : Massachusetts system Pumping Record am 4 -- system Pumping Record OCT 3 0 2001 system Owner system Location ABCI PTT C.). ALC Buc 1175 TL*F,! FTKF ST 1175 TURNPIKE FTRF-ET NOg jNL1 VT:P MA 01845-6155 North Andover, 14A 01945 f975) 686-0363 (978) 686-0383 Type: Emergency Routine Cesspool: iVo Yes Date of Pumping: 5Rd17 -w o, system Pumped By: Wind Riwer Enwwwnlo% LLC Contents transferred to: Contents Disposed at: Date: Pumper signature: CwWitian of system/Other Comments Septic tank: No =Yes Quantity Pumped:���llcns Permit #: SJR lain Dep Approved From - 12/07/95 Commonwealth of Massachusetss : Massachusetts System Pumping Record Form 4 -- System Pumping Record OCT ?001 System Owner System Location - ALC UJS Cc, ABC Bu:: 1175 'MIRNPIVE ST 1175 'TMiR"1F'I <k STREET NORTH AWOVbP MA 0184P -611i5 North Andover. MA n1845 (976) 666-0333 (9,7131 686038_ Type: Emergency Routine Cesspool: No Yes Septic tank:No Yes rIM Date of Pumping: Quantity Pumped: Ilona System Pumped By: Wind River Environmental, LLC Permit #: Contents transferred to: Contents Disposed at: Date: Pumper Signature: E�)/q .y. of system/Other Comments Dep Appmved Fmm - 12/07/95 p�r;ry�ceaJ e:yst.:.0 ABC BUS Q0. 1175 '11JRNPIKE ST 14(](t1'H AtT(X)'I it MA Ol64 i 61` �^7dl 6dti-43H.3 Type: Emergency Cesspool: No Date of Pumping: / 1 System Pumped By: Contents transferred to: Contents Disposed at: Commonwealth of Massachusetss : Massachusetts System Pumoina Record Routine Yes Wind River Environmental, LLC Date: C D (D io i Pumper Signature: Condition of Syst.WOther Comments Location ABC Buc 11.71, Tf.1RtiE'IICL' S"1TEL"' NQr th AndGVC!L MA ClIU45 (-79) 686-0381 Dep Approved from - 12/07/95 Form 4 -- System Pumping Record OCT 2 5 2001 Septic tank: Klo =Yes [� Quantity Pumped: a 5 0 p Gallons Permit #: 1 v/�dC-, System Owner k3c BUS Co. 117" TU12Iipin sr KORT? ANIX-VER, MA 01895-•6155 (978) 686-0383 Type: Em Cesspool: No Date of Pumping: System Pumped By: Contents transferred to: Contents Disposed at: 0 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record Routine Yes Wind River Environmental, LLC Date: /01 1 O JU f Pumper Signature: ture: Condition of Systen✓Other Comments OCT 2 5 2006 system Location ABC BUD 1175 TURNPIKE S"'RJEr North A_ridover. MA 01845 (97+1) 686-0383 Septic tank: No F-jYe. Quantity Pumped: aS O D Gallons Permit #: �-rs> 16lV pM Dep Approved from - 12/07/95 G r System Owner 2175 V)11*11FI!' ST VORTH ANDDVER. i'(A 01835-6155 t 97R) 636-0383 Type: Emergency Cesspool: No Date of Pumping: !� (I Commonwealth of Massachusetss : Massachusetts System Pumping Record Routine Yes System Pumped By: Wind River Environownfa/, LLC Contents transferred to: iystem Location A2r,, Buv 1175 P.'Prf.prKT Worth Andov.�+r, MA 01845 ( 978, W-0.83 Contents Disposed at; Gp- L SP Date: 61 I ( � ( b' Pumper Signature: Dep Approved From - 12107105 Form 4 -- System Pumping Record -- Ze 2tiJ� Septic tank: No FT -s Quantity Pumped: p Gallons Permit #: 11 c System Owneru _ .,, 1175 IIJAMIKV S.i L40PTH ;�VLQVER HA 131045 6155 666 083 Type: Emergency Cesspool: w ✓� Date of Pumping: Commonwealth of Massachusetss : Massachusetts System Pumping Record Routine Yes System Pumped By: Wind River Environmental, LLC Contents transferred to: Contents Disposed at: C, , ! Date: //aPumper Condition of System/Other Comments iystem Location ACC BuS 1175 Wr"!PTKI; STREM' Worth Andcrvrer, PA 01645 (978) FAG -0363 Form 4 -- System Pumping Record 12 4 L_ Septic tank: W =Yes [� Quantity Pumped: 9SCC) Gallons Permit #: Dep Approved From - 12/07/95 AI"', S)JS CC) 1175 TUFNPIK 5"r 110M. AC33X ER eA 01045-0155 p97..> 666-0305 Type: Emergency Cesspool: w Date of Pumping: Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record Location ABC Bua 1171, T1JPIIv I:W 3Tf;M North Andover, KA 01045 mei 6r36 -0303 Routine Yes System Pumped By: Wind River Environmental, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumper Signature: Dep Approved from - 12/07/95 Septic tank: No -Ten�--' �s Quantity Pumped: —'—KCIbns Permit #: Commonwealth of Massachusetss : Massachusetts System Pumping Record .SBC C %3 : O 117", 'Ut 7Vxll!-K 9f t,10971i a'TtKlYitt. PLS, 01845-615M11 r9^8} 686-11363 Type: Emergency Routine Cesspool: No Yes Date of Pumping: System Pumped By: Wind River Environmental, LLC ystem Location ARC BU " 105 TVP,*1?RFE a:FEET N,itth �,ndovoc, MA 0184i {978„ 636-0383 Contents transferred to: Contents Disposed at: / Date: Pumper Signature: Condition of Syst.WOther Comments Dep Approved from - 12107195 Form 4 -- System Pumping Record C azar C. Septic tank: No =Yes Quantity Pumped; lions Permit #: System Owner ALV. IUJr'i CYJ. I t 7 4 TURNPIKE ST n y trt�'-it't'H AtdMVER. MA u1845-61515 (978) 586-0383 Type: Emergency Cesspool: hto Date of Pumping: System Pumped By: Contents transferred to: Contents Disposed at: Date: Commonwealth of Massachusetss : Massachusetts System Pumoina Record Routine Yes 471.7 1 Wind River Environmental, LLC of System/Other Comments Pumper iystem Location ASC BU:_ 3,175 Ti1RtIPIKH S"lF KI North Andover. HA PIC45 (976) 165-0381, S/, Dep Approved from - 12/07/95 Form 4 - System Pumping Record . r., L r 24 Septic tank: Wo =Yes Quantity Pumped: ns Permit #: System Owner Type: Em Cesspool: No Date of Pumping: System Pumped By: Contents transferred to: Contents Disposed at: Date: Commonwealth of Massachusetss Massachusetts System Pumoirw Record Location Routine Yes Wind AMP Environmental, LLC of System/Other Comments Pumper Signature: Dep Approved from - 12/07/95 Form^4 -- System Pumping Record or r 24 Septic tank:Aig sQuantity Pumped:Ilons Permit #: System Owner 1175 TURNPIKE 8T 1WRTH &Ir#)VB*V. MA 01645-6155 (,076) 666-0163 Type: Emergency Cesspool: Mo Date of Pumping: System Pumped By Contents transferred to: Contents Disposed at: Commonwealth of Massaehusetss : Massachusetts System Pumping Record System Location �- ABC enz: 2175 TIIWPIU FTM -Fr Routine Yes Wind River Environmental, LLC Date: Pumper Signature: Condition of System/Other Comments North,Andover MA. 01595 (97Ri E66-0383 sr r Dep Approved From - 12/07/95 Form 4 -- System Pumping Record Septic tank: WbYes Quantity Pumped: ns Permit #: rvicost oyatciv, V -r- BADS CX) 11?5 TUM-PPIKE ST XATH AlNL�NKR. NA 01845-6155 (970) 683-0383 Commonwealth of Mossachusetss : Massachusetts System Pumping Record System Location 5 - ABC Bur: 11?5 TiRVFIK:: S`-FFT Wrth Andover. HA 01845 j978i 686-0a$3 Type: Emergency Cesspool: No Date of Pumping: Routine _ Yes System Pumped By: Wind River Enwmninentoi, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumper Signature: Dep Approved From - 12107195 Form 4 -- System Pumping Record Septic tank: !��sQuantity Pumped:Ions Permit #: 6 3 200( Commonwealth of Mossachusetss : Massachusetts System Pumoirm Record System Owner System Location ABC BUS CO ABC Bus 1175 TURNPIKE :,1' 1175 TumpirE 'STR.E r NUI?CN At3Tx3V�?R, MA 41845 6155 North Andovor, MA 01645 ;(9781 686-0383 (978) 686-0383 Type: Emergency Routine Cesspool: t4o Ycs Date of Pumping: System Pumped By: Wind River Enviromnentc% LLC Contents transferred to: Contents Disposed at: Gr �� Date: Pumper Signature: Condition of System/Other Comments Dep Approved Fran► - 12/07/95 Form 4 -- System Pumping Record Septic tank: w Yes [E' Quantity Pumped: Gallons Permit #: - TOW g of HE ANDOVER/ lSID IC041 syotefU ct-quf'foll. & run BW, CC 1175 WWRIKE ST NORTH ANLOVOI HA 01BA5-6155 (978) 686-0383 Type: Emergency Cesspool: Mo Date of Pumping: j ' , ( Commonwealth of Massachusetss : Massachusetts System Pumping Record Routine Yes System Pumped By: Wind Rivrrr Environmental, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumper system L=atidn f d ABC fuvk 1iA -!PNPB'. SPF. r North Andover, MA (;1$4" i Si Dep Appnved from - 12/07/95 Form 4 -- System Pumping Record Septic tank: No Yes Quantity Pumped: 7,5alkms Permit #: ABC 131JS GJ. 1175 tURWITu1? ST UORTH eANO7V1:. , MA 0184:;-615t (978) 606-0363 Type: Emergency Cesspool: No Date of Pumping: ' -�l Commonwealth of Mossachusetss : Massachusetts System Pumping Record Routine Yes System Pumped By: Wind River Ein4ronmeMn/, LLC Contents transferred to: Contents Disposed at: Date: Pumper Signature: of System/Other Comments Location ABA' Luc 111 KJ 1�IF`.l LIKE MEET Borth AnJowr, !'A 01.845 ('178) 686-0138.3 W� Dep Approved from - 12/07/95 Form 4 -- System Pumping Record Septic tank: No Yes Quantity Pumped: Z �6aibns��s Permit #: L - xce(A C;ya7tEaq. Liver. to t i 1- ru ABC BUS t 1_f 1175 TU TIPIKE ST r. R'1TH ACIT.l.1VBR. MA 01645-6155 ( 970) 6d6-0383 Type: Emergency Cesspool: No Date of Pumping: Q� Commonwealth of Massachusetss : Massachusetts System Pumping Record Routine Yes System Pumped By: Wind River EnvOonmental, LLC Contents transferred to: Contents Disposed at: Daft: of System/Other Comments CczL5- Pumper Signature: Location APC BUN 1175 Tf04PIKE SINMET Dorth Andovor. HA 01845 ( 978) 686-41383 Dep Approved from - 12/07/95 Form 4 -- System Pumping Record Septic tank: No =Yes Quantity Pumped: I 50 Gallons Permit #: Tt" dtr ` C•. i JUL 2 3 2001 Form 4 -- System Pumping Record - Commonwealth of Mossachusetss : Massachusetts System Pumoino Record System Owner System Location Type: EmergencyE,:d Routine Cesspool: w Yes Septic tank: w Yes Date of Pumping: Quantity Pumped: �C_JCk�ahlions 7 r System Pumped By: Wind Plum Environmental, LLC Permit #: Contents transferred to: Contents Disposed at: Date: of System/Other Comments Dep Approved From - 12/07/95 N OF NORTH ANDOVER/ RQAr?lB OF HEALTH ,- - 9 3 0 2pni Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Puunoina Record System owner ABC BUS CO. 1175 TW4"PIKE STREET 11OP.TH ANWVER, MA 01895 (978) 686-0383 tem Location ABC Bus 1175 TUFNPIKE STFE2T North Andover, MA 01895+ (978) 686-0383 Tom' E^er9encYRoutine - L Cesspool: hb Yes Date of Pumping: (f 1 / System Pumped By: Wind Rivrr Environmental, LLC Contents transferred to: Contents Disposed at: Date: Of System/other Comments r S� Signature: Dep Appnved from - 12/07/95 Septic tank: Wo —IYes� Quantity Pumped: lion Permit #: a�JJio'N0- � APR 3 0 2001 Owner _ Form 4 -- System Pumping Record Commonwealth of Mossachusetss : Massachusetts System Pumping Record Location Type: Emergency Routine Cesspool: WE��r Yes Septic tank: No =Yes �— Date of Pumping: ( Quantity Pumped: Soo Gallons System Pumped By: Wind River Enwromnenta/, LLC Permit #: Contents transferred to: Contents Disposed at: , ^ `S Date: t—/i v Pumper Signature: Condition of Syste Comments Dep Approved from - 12/07/95 Hose Z: 65UU Uai. wa System Owner ABCs LUS CO. 1175 TURNPIKE STP.EET NOWni ANDOVER, rJA 01845 078) 686-0383 Type: Emergency Cesspool: No Date of Pumping: System Pumped By: Contents transferred to: Contents Disposed at: Commonwealth of Massachusetss : Massachusetts System Pumpina Record Routine ,U Wind River Enviromnento% LLC Form 4 -- System Pumping Record tem Location ABC Bus 1175 TURNPIKE STREi:T D?orth Andover, MA 01845 t*91te) 686-0383 /S Septic tank: No =Yes Quantity Pumped:QSZ�lons Permit #: Dep Approved from - 1 Z107195 A " " stem Owner ABC BUS CO. 1175 TURNPIKE STREET NORTH ANDOVER, MA 01345 (978) 686-0383 Type: Emergency Cesspool: W Date of Pumping: 7 System Pumped By: Contents transferred to: Contents Disposed at: Date: Of Commonwealth of Massachusetss : Massachusetts System Pumoirrg Record Routine Yes Wind River Envimminental, LLC Dther Comments Form 4 -- System Pumping Record tem Location ABC Bus 1175 TURNPIKE STREET North Andover, MA 01845 (978) 686-•0383 Dep Approved from - 12/07/95 Septic tank: No Yes ©I Quantity Pumped: `? SOv Gallons Permit #: Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumoinw Record System Owner System Location ABC BUS CO. ABC B119 . 1175 TURNPIKE STREET 1175 TURNPIKE STREET NORTH ANDOVER, MA 01845 North Andover, MA 01845 . (978) 686-0383 (978) 686--0383 Type: Emergency Routine Cesspool: W Yes Septic tank: W =Yes ©� Date of Pumping: Quantity Pumped: `ds o v Gallons System Pumped By: Wind River Enwrwunenta/, LLC Permit #: Contents transferred to: Contents Disposed at: / — LS Date: 6 (a Pumper Signature: Condition of System/Other Comments Dep Approved from - 12/07/95 �hs0� C rgt4 OFA OF �iL�µe 0A,,�V Commonwealth of Massachusetss : Massachusetts System Pumoina Record it Form 4 -- System Pumping Record System Owner System Location ABC BUS Co. ABC Bus 1175 TURNPIKE STREET 1175 'TURNPIKE STREET NORTH ANDOVER. MA' 01.845 North Andover, 14A 01845 (978) 686-0383 ,r (978) 686-0383 Type: Emergency Routine Cesspool: W Yes Septic tank: NoYes Date of Pumping: r - Quantify Pumped: Ions System Pumped By: Wmd River Environmental, LLC Permit 7l: Contents transferred to: Contents Disposed at: Date: of System/Other Comments 15 Pumper Signature: Dep Approved Froin - 12/07/95 .. Commonwealth of Massachusetss : Massachusetts System Pumping Record System Owner , '7.,� C a Type: Emergency Routine Cesspool: No Yes Date of Pumping: - System Pumped By: Wind Riwrr Envftnn►enfo% LLC Contents trwnsferred to: Contents Disposed at: Date: Pumper Condition of System/Other Comments Location Dep Approved from - 12/07/95 Form 4 -- System Pumping Record Septic tank: w =Yes E Quantity Pumped:j�j Gallons Permit #: ��Ae.b._ �fG i -- vi ...,. ni rnl:.arn Lr -Y" wli:n System `.r0 u Ge 1 COS ;BC BUSS CO. 1175 IURNPIKE STREET IORTH ANDOVER, MA 01845 ;978) 686-0383 Type: Emergency Cesspool: No Date of Pumping: r v 1 Commonwealth of Massachusetss : Massachusetts System Pumoina Record Routine Yes System Pumped By: Wind River Environmental, LLC Contents transferred to: r C Contents Disposed at: Date: L r J U Pumper Signature: rCordition of Systen✓Other Comments System Location ABC Bus 1175 TURNPIKE STREET North Andover, MA 01845 (978) 686-0383 Dep Approved from - 12/07/95 Foran 4 -- System Pumping Record 13/QuSeptic tank: w =Yes [13-- Quantity antity Pumped: 9s. a 0 Gallons Permit #: E43�^�?c�'+3F H�FrLii-i� 0 4 ?nni Commonwealth of Mossachusetss : Massachusetts System Pumping Record System Owner /? ws ti`-' Type: Emergency Routine Cesspool: W Yes Date of Pumping: / System Pumped By: Wind River Environn►enta/, LLC Contents transferred to: Contents Disposed at: Location Date: Pumper Signature: \� Condition of System/Other Comments Form 4 -- System Pumping Record Septic tank: No =Yes Quantity Pumped: _Z�llons Permit #: OF i WTH AMDOVER/ Dep Approved From - 12/07/95 BOARD OF HEALTH MAY 8 2001 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumoina Record System Owner / System 4.ocation � )C� 11 7Ain 11 ,a 0 s �.7 1 Type: Emergency Routine Cesspool: NoE Y5 Septic tank: W ElYes EfT Date of Pumping: 42 67 Quantity Pumped: r► ns Date: Pumper signature: condition of System/Other Comments Dep Approved From - 12/07/95 Commonwealth of Massachusetss : Massachusetts System Pumoirm Record System Owner ABC BUS a) . 1175 TLWIPIKE ST N7RTEi ANMVER, MA 01845-6155 (978) 686-0383 Type: Emergency Rov Cesspool: No Yes r / Date of Pumping: r System Pumped By: Wind Riva Environrnrntal, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Form 4 -- System Pumping Record System Location *' ABC Bus 1175 TURNPIKE STREET North Andover, MA 01845 (978) 686-0383 Pumper Signature: TI�w Dep Approved from - 12/07/95 Septic tank:I&I El/ ityQuantPumped:ns Permit it: tv:s' SUN � 2oor � 4 r Form 4 -- System Pumping Record Commonwealth of Massachusetss Massachusetts System Pumig a Record System Owner - ` -- System Location AbC LITS (X), Aac BvIc 1175 71JR r"PIKE ST 1175 TURNPIKE ST'REEr NDRTH AND-21/LR, Mrd 0104;-6155 North ,andover. MA J1845 078) 06-03W.i ( 978) 646-0393 Type: Emergency Routine Cesspool: w Yes Septic tank: w Oyes E) Date of Pumping: '� (- 0 Quantity Pumped: 25 -QR!) 6aibns System Pumped By: Wind River Ens4rwMeafoi, LLC Permit Contents transferred to: Contents Disposed at: Date: of System/Other Comments : J�)� Dep Approved Fran► - 12/07/95 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumpina Record stun Owner✓» v W _ , .., . , » y m Location 5 tf3 /01 Servicod vyutam Runback; riding high. 7.510 u< L S Y� ADC E:US CD AP,G Euo 1175 `i WIN IK.B FU 1175 Tn_IFIV IK.E 5 n7T' BT 143R'Ill AI COVE li . 144 01845-6155 Borth Andover, NIA 01845 Type: Emergency Routine Cesspool: w Yes Septic tank: No =Yes rul Date of Pumping: \ o Quantity Pumped: slop Gallons System Pumped By: Wind River Environmental, LLC Permit #: Contents transferred to: Contents Disposed at: Date: dl V 1 Pumper Signature: Condition of System/Other Comments G -L S�> (1121 Dep Approved From - 12/07/95 tc DEC - 3 20 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumoino Record System Owner System Location ABC NIS CO. ABC Boo .1170i TURNPIKE .STY - - _. .. 3.1,75 TURNPIKE STREET _.. ;#ORi7i ANWVEk, MA 01845--6155 North Andover. MA 03.845 (378) 686-0383 (9791 6s6-0383 Type: Emergency Routine Cesspool: W Yes Septic tank: IVo Yes Date of Pumping: U I Quantity Pumped: 6ullons System Pumped By: Wind River Enwromnento% LLC Permit #: Contents transferred to: Contents Disposed at: {DIzS-S� Date: Pumper Signature: Condition of System/Other Comments Dep Approved From - 12/07/95 5 ystem Owner BC BUS CY) 1175 TURNPIKE ST ORTH i0MUVER- MA 01E45 -6U55 97L1) 606-0381 Type: Emergency Cesspool: W Date of Pumping'. System Pumped By: Contents transferred to: Contents Disposed at: Commonwealth of Massachusetss : Massachusetts System Pumping Record 77Routine Yes " i Wind River Environmental LLC Date: Pumper Signature: lCondition of SysterWOther Comments System Location ABC Bun 1175 TURNPIKE ST'REE'T North Andovor. MA U1845 (9781 686-0333 Dep Approved From - 12107195 Form 4, -CSy3Pompih BOAR M NOV 1 4 N01 Septic tank: W Yes F7T Quantity Pumped: llons Permit Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record System Owner System.Location ABC FHfr, a) ^ ' 2 TV ABC Purr _ 1 1175 TUP gPIKE ST 11.75 ' 11WIF IrE 5TPI 00RTH ANDOVER. r4A 01845-613 - North-"Andovcr. MA 01845 (3'74) 686-0383 ,. e" (478).686-0383 Type: Emergency Routine Cesspool: No Yes Septic tank: W =Yes Date of Pumping: c Quantity Pumped: 2 lions System Pumped By: Wind River Environmentoi, LLC Permit Contents transferred to: Contents Disposed at: ca� 1 �� Date: of System/Other Comments Pumper Signature: Dep Approved from - 12/07/95 A Commonwealth of Massachusetss Massachusetts, -,-k/ �. System . Pumnirio'Record 4 } t Form 4 -- System Pumping Record System Owner System Location ABC EUS 0), ABC Bur 1171`_� T'tJPOPIKE ST 1175 T+)MP:KE STREET NO:TH ANT)QVEP,,IK*, O1045-6155 Ai North Andover, MA 01845 (97n) 686._0383t' (9T8j 586-0583 Type: Emergency Routine Cesspool: No Yes Septic tank-. No Yes Date of Pumping: p? G / Quantity Pumped: _:i��llons System Pumped By: Wind River Environmental, LLC Permit ?l: Contents transferred to: Contents Disposed at: of System/Other Comments CLS ; Pumaer Sionature: Dep Approved from - 12/07/95 Form 4 -- System Pumping Record Commonwealth of Mossachusetss .y A%ssachusetts Svstem�Pumg_ina Record System Owner) ,f' System Location Type: Emergency Routine Cesspool: No Yes Septic tank: No Yes Date of Pumping: 6 Quantity Pumped: Ions System Pumped By: Wind River Environmental, LLC Permit 7t: Contents transferred to: Contents Disposed at: Date: of 5ystem/Other Comments Pumper Dep Approved from - 12/07/95 / 9 -/2,— �L W .. 0- l i O Form 4 -- System Pumping Record Commonwealth of Massachusetss Massachusetts System Pumping Record Sysin �„aOwiir 5 u o nose z 5 System Location ABC BUS CO. ABC Bus 1175 TURNPIKE STREET.' 1175 TURNPIKE STREET NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 (978) 686-0383 (978) 686-0383 Type: Emergency Routine Cesspool: No Yes Septic tank: IVa =Yes Date of Pumping: Q Quantity Pumped -/S-A�2 6allons System Pumped By: Wind River Environmental LLC Permit 7t: Contents transferred to: Contents Disposed at: Date: Pumper Dep Approved from - 12107195 Form 4 -- system Pumping Record Commonwealth of Massachusetss Massachusetts r e system Pumping Record - System Owner Type: Emergency Cesspool: No Date of Pumping: C System Pumped By: contents transferred to: Routine Yes rof. Wind Blum Enwronmientai, LLC Contents Disposed at: Date: V'��/ Pumper Signature. Condition of systeWother. comments Location Dep Appmoved from - 12/07/95 Septic tank: No Yes —+ �j Quantity Pumped: �Ob Gallons Permit ill: r ., 04-4 CURRIER. SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD COMMONWEALTH OF MASSACHUSETTS - MASSACHUSETTS S YS TEM PUMPING 4ING RECORD SYSTEM OWNER: SYSTEM LOCATION: C 9-603' 615 - DATE OF PUMPING:- 6-C: QUANTITY PUMPED: CGALLONS CESSPOOL: NO YES FT YES SEPTIC TANK: NO F SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE:INSPECTOR: A C.URRIER - SE'PTI.C,&- DRAIN S-IRV,CE 107 FORE'S'T`STRE BT; (978') 714-41 772 �r'�`' 1. ON I — - �S�11-1'411PUAIPINq_& �( --- S'YSTEM 0WNER-- SYSTEM LOCkTION: DATE OF 20 -MAN Imo' PON/-., I "'y - "ED: CESSPOOL: NoyEs SEPTIC TA ',N' - -K-: SYSTEM p* Ur",Qz-m BY: CI i R—smpauc DR sp- DR VIC CONTENTS TRANSFERRZI-D -rcj:— DAT 2: SPECT0ju 4. SySTEIVA II Ld 4�"0;45c, -471d�bdS : L,064 Id WUST:Lo ;�; HSbn6H7 i0dS 3-1,11­ddds : Xa-� ol FORM 4 - SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 COMMONWEALTH OF MASSACHUSETTS " ° �`f -1 d Dy e , MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION: n DATE OF PUMPING: (Pf/ o v QUANTITY PUMPED: CESSPOOL: NO YES F-� SEPTIC TANK SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: cq S DATE: asd GALLONS NO F-] YES 0/ INSPECTOR- k coo .% 14 CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD AUG -8- SYSTEM 8 r . �. i COMMONWEALTH OF MASSACHUSETTS //'I '-t do v c- — , MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: L�� s F 7 S k -A v- u, Jvv-P-,/-- SYSTEM LOCATION: � DATE OF PUMPING: -�o UANTITY PUMPED: CESSPOOL: NO 'YES F--] SEPTIC TANK: SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: G t S '9-50 <�) GALLONS NO F--] YES 0 DATE: `� �� INSPECTOR: d \ t1t_ ll CURRIER SEPTIC & DRAIN SERVICE I07 FOREST STREET, MjDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPIN6 RECORD fi .. JUL g COMMONWEALTH OF MASSACHUSETTS-` MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: /1 13 SYSTEMLOCATION: NQ VL (Pk 63 02 DATE OF PUMPING: /�o�166 QUANTITY PUMPED: PS�O GALLONS CESSPOOL: NO CJ -YES � L_I SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO:,C-� C DATE: INSPECTOR: FORM 4 - SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 C mmO ALTH OF MASSACHUSETTS MASSACIiUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION: DATE OF PUMPING: �O QUANTITY PUMPED: aZ��o GALLONS CESSPOOL: NO �;y YES a SEPTIC TANK: NO E:] YES X SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: INSPECTOR: DATE. CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD /COMMONWEALTH OF MASSACHUSETTS V G • A ►? C' D , l e� , MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER:SYSTEM LOCATION: AK'�sC. 11 75 �-- +z DATE OF PUMPING: QUANTITY PUMPED: ';?00C) GALLONS CESSPOOL: NO E:] YES 0 SEPTIC TANK: NO YES E:g_ SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: L -2-D DATE:_ Y- - Cj INSPECTOR: ;4AY - .c 14, FORM 4 - SYSTEM PUMPING RECORD "',1 U, t i SER SEPTIC, & DRAiN SERVICE 107, FOREST,STREET,, IVMDLETON, MA -0 : 1949 .. 74-2772 k; � F 4'ST i COMMONWEALTH, OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD cm3 A s SYSTEM OWNER ` SYSTEM LOCATION: rl - �- ';a z' y� �a e c - / 00 DATE I3F�PCJ1ViPING QUANTITY PUMPED: ,�`� GALLONS W ,OSSPOOL NO ' YES a SEPTIC TANK: NO YES sy, YSYTEM PUMPED BY CURRIER SEPTIC &DRAIN SERVICE vu 7 r TENTS'TRANSFERRED`TO r • S•� � F N qtr k,: INSPECTOR: �� { �4�r am" w� d��I:TRRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD CO ONWEALTH OF MASSACHUSETTS iy • U Ute' Q , MASSACHUSETTS SYSTEM PUMPING RECORD SYS �{T(/E(�M(/OWNERj: ( , f l \ \ItlAvickv"al'- DATE OF PUMPING: SYSTEM LOCATION: G)r �A s � QUANTITY PUMPED: �10 v GALLONS _CESSPOOL: NO EE -YES a SEPTIC TANK: SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE .CONTENTS TRANSFERRED TO: ` -S NO F7 YES } URRIER z SEPTIC & DRAIN SERVICE 1 r FOREST STREET; 'MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD CpM�%j�ONWO EALTH OF MASSACHUSETTS MASSACHUSETTS f _ .R� . SYSTEM PUMPING RECORD k SYSTEM OWNER: l SYSTEM LOCATION: D � jk % ✓ l � 0 LA CA Nd,:, 39'? k DATE OF PUMPING: QUANTITY PUMPED: GALLONS CESSPOOL: NO '. n SEPTIC TANK: 41 , SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: C� NO a YES �-- ..3 -N �U �d x .. DATE: INSPECTOR: rl FEB 3 1-0 �-k(, (I fo (-,-ad 0C) neTF nR PTTMPWCT• l� -OUANTITY PUMPED: GALLONS NO YES F -q - _— DATE: /� -� INSPECTOR:1, e YCo � f Xan CU:WER -SEPTIC& DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 fs FORM 4 - SYSTEM PUMPING RECORD COMMON;FEALTH OF MASSACHUSETTS A vl MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: CA5 PZ JU, A vJ ou- etl�l SYSTEM LOCATION: e, op T�� u, Sr s- e � eo DATE OF PUMPING:-�%QUANTITY PUMPED: O9 -r6 CESSPOOL: NO [12"YEs SEPTIC TANK: NO GALLONS YES:� FORM 4 - SYSTEM PUMPING RECORD TRR�ER SEPTIC & DRAIN SERVICE 107 FOREST STREET: MIDDLETON, MA 01949 (978) 774-2772 /C ��MMONWEALTH OF MASSACHUSETTS /W- A,Jo,tV- ,MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: DATE OF PUMPNG: CESSPOOL: NO YES SYSTEM LOCATION: S/1 t QUANTITY PUMPED: S }" SEPTIC TANK SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: c� C' s b GALLONS NO 0 YES �- DATE: < < I � 0kf' INSPECTOR: � b -t FORM 4 - SYSTEM PUMPING RECORD i fes, s,. j amu- ° F. �COMMONN EALTH OF MASSACHTJSETTS A6 . 1q� () V(f C , MASSACHUSETTS Sl S'7' MPUMPING RECORD ...^, SYSTEM LOCATION: a� 4 u c) u DATE OF PUMPING: QUANTITY PUMPED: Oa 0 GALLONS. YES Y c T u h E SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD COMMrLv EALTHOF MASSACHUSET I'S �%. A,/? 6,r , MASSACFUSETTS S YS TEM PU61PING RECQI�'D SYSTEM OWNER: �j� '9U SYSTEM LOCATION: i/ J DATE OF PUMPING: a �S QUANTITY PU1 ✓IPED: GALLONS' CESSPOOL: NO 0 YES F--] SEPTIC TAr fK: NO SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SE EZVICE CONTENTS TRANSFERRED TO: S�S� DATE: / r �/ INSPECTOR: �9 �� IV 4 a t - /6' }�lvl�ly { aw 'k I'll 11 anw>,i'3,$.��'.�J��n`.+.:2s�'9`-3 •':e^S 2: r'�''.�k-„,3s!?' 4 ` r FORMA— SYS'I'�I�fi PUTmPING RECORD :., v-” F.-, °m }i'Yf1�/O.l�. l:.:�1 �a C `Pvfp�EtJiv �� �1au"i"If C?? NIASSAC!J!j 5I'`)--jS k 7-1M t Jt3,� ?_�S ,,., y. - Pi9 1.. s5._y-Ws..1•,� wl 11"f b', S`'S`1.Iil� 04r'Nr�� f.`r'-^---. .._. . _ _ --�-----� .. �.-------.-•� _.,.�-_....._._. ... �,� Pf i ✓. � - � /, - - F_, ✓ 1. `.:� fir• 4 s , j ,j 3 NK: ��TT T �r P.iJ15�lLSrt f): )3�F: � i 4� �1.! F {�vS ellSL ;'ti!.III C4 J! TENT 1 a ISA E: lit r � � a.+,f„ ,_ • � I; p� ,T,k ® 2(—� 1_ ' 'on r � a m aK �" ..:« y w r •., .5 .> dip ,f a ey' 107 Forest St. Middleton, MA 01949 (508) 774-2772 J •stem ID P�N FORM 4 - SYSTEM PIA, 2Pp\G RECORD S�Q�gE�v`C� Commonwealth of Massachusetts Massachusetts Svstem Piimn7e"Cr Record system 0 r 70, 04e. Date of Pumping: 117 Quantity Pumped:.ZE�V—gallons Cesspool: No ❑ Yes _❑ Septic Tank: No ❑ Yes (� System Pumped by: /�� P � % �`�� Contents transferred to: License : Date Inspector Gj Cj,