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Miscellaneous - 1560 SALEM STREET 4/30/2018 (2)
1560 SALEM STREET 210/106.6-0055-0000.0 1 _ Commonwealth of Massachusetts w W City/Town of North 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. I A. Facility Information Important When filling out forms 1. System Location: ' RECEIVED on the computer, use only the tab 5(00 -- key to move your Address �� - cursor-do not North Andover use the return --- -----------.._..------_—_ .- -----------.._T0VVN_0F=RTH Ft --- key. Citylfown State HEALTH DEPP-&, O e 2. System Owner: Name I �n Address(if different from location) City/Town State Zip Code Telephone Number 13. Pumping Record_ 1. Date of Pumping 2. QuantityPumped: -- ---- - Date p Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): ----- - --- ----- ------ -----... - - - - 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: -6—System Pum Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date --- ignature of ReceivingF --acilityy-- _ -Date---*----------------- - t5form4.doc•03/06 System Pumping Record•Page 1 of 1 - 1ECEIVIED Commonwealth Of Massachusett City/�Town ®f N® And®verTOWSystem Pumping Rec®rd1, 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 you local Board of Health to determine the form they use. The System Pumping Record must be submitted tc the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, <- \� use only the tab C key to move your Address cmor-do not No-Andover - Ma• — — — use the return` ` key. City/Town State Zip Code 2. System Own LL 1�fb 0 Y):e � �. Name - 2Jon Address(if different from location) City/Town State Zi Co 2e S70 Telephone Number B. Pumping Record 1. Date of Pumping Date L 2. Quantity Pumped: /4d Gallons 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes K No if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Od 0 02 6. Syste Pumped By: �,c P� Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stew ' Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 S' t Date na eiving Facility Date t5form4.doc 03!06 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of No , ndover JUN 10 2013 System Pumping Record TOWN OFNORTH 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab /5 C SQC-'r 60 r� S-)`- key to move your Address cursor.-do not No andover Ma use the return key. Cityrrown State Zip Code , 2. System Owner: Ogrb�Pe1� Name seam Address(if different from location) City/Town State Zip Code - - - —- -- Telephcne Number B. Pumping Record 1. Date of Pumping te 3J f Date Gallons 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap I ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6_000 6. System Pumped By: /Y/ Name v Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: SteQa'rt's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Si nature f er Date Signat e o '_' Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Date8728 ��/C/ .�1 . Rl HORfM °� °.;•.�"o°� TOWN OF NORTH AND 'fR k; ' PERMIT FOR PLUMBING This certifies that .! 4C . . . . . f. . . . . . . . . `_ . has permission to perform . . .�o. ?4 . . . . .. !4.. . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . at . J -5-A00. . . . . : �� ,ze,.,. . . .5 1f— . . . ., NortIXAndovq, Mass. FelO.Lic. No. 5.G� . . . . . . ��R �. . . PLUMBING INSPE&OR Check +v . L a p 1xii u N vo It im14,10 rv' r r �mm«I N O O x O O mOO A a 10 DC WATER CLOSETS KITCHEN SINKS {/ ti. EI 1 LAVATORIES 2 .� • 3 BATHTUBS 0 SHOWER STALLS o� DISHWASHERS 0 3. ` V �, DISPOSERS q.'r R RR LAUNDRY TRAYS W WASN.,MACH. CONN. .� g NOT WATER TANKS TANKLESS O CO33 n SLOP SINKS m 2 FLOOR BRAINS ' OAS TRAPS 10 m O ❑ URINALS r, m DRINKING FOUNTAIN ® ABU DRAIN 1)6 �' a 10 Nil WATER PIPING �. ROOF DRAINS. g © EAGKFLOW PREY. o 140 v cel a, OTHER FIXTURESI .� C 13 �IL .. 7460 Date. ..... � x NORT.p TOWN OF NORTH ANDOVER f D • PERMIT FOR GAS INSTALLATION �4SSAC MUSEt•( This certifies that . . .: +.t1./� .{ . . . . . . . . . . . . . . . has permission for gas installation A . . .w1a f 4A . . . t . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at; North ndover, ass. FeeLic. No..1.3.5JO.c6. a AS INSPECTOR. Check# : ,i f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GACFrFTI ATG_, Mass Date BuildingLocation�o�� t !^'i ,-4- Owaers xame ,y/�jL r/�, zacr - Type 0 Occupancy _ New 0 Renovation Q Replacement E7Plans Subnmitted Yes No x — m 0 v� M W 0 f�EeeS '{ zaH10 @Ad1O � Ea SUB-Bsmr BASEMENT 1SPFLOOR FLOOR 3RD FLOOR 4TH FLOOR SM FLOOR GMFLOOR 7M FLOOR SPH FLOOR installing CAmpany Name Check One: Certificate Address: �� 2 7 Corporation /l� Partnership B Telephone � l � CeI174f���" /A/0 um/CO. Name of Licensed Plumber or Gas Fitter r ,sem 3NSQRANCE COVERAGE _ I have a currant liability imuran No ca its mal equivalent which meets the requirements of MGL Ch 142. Yes [ErIfyoa have checked M please indicate the type coverage by cog the app ulmaw box. A liability insurance policy Offier type of imdemnity Bond. OWNERS MURANCE NAIVE I am aware that the licen=—does not bave the msm=coverage required by chapter 142 of the Mass.Genial Laws.and that ury signature on this permit application waives this went Chec3k one: Owner Q Agent El Signature of Owner or Ownees Agent I hereby certify that all of the details and information I have submitted.(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comphance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the general laws. / =t-- - o - a o Undergrotled License N`i'b= • RECEIVED '1`0 WN U N C)X-1 N Di-i'v( sYS'1`Et�1 PUMf'I "-(I ,4,"l.: SEP - 7 2005 UA , k � �/1S . TOWN OF NQRTH ANDOVER Y STM1 OWNER - ___.____.._-� HEALTH DEPARTMENT DKES5 7- -_ ._.._ _ _ __..._..-...__..._ 0�� .. 6 u�r�o; s .. _ QlJhht7 1 Y PUMPF .._..__. SA rUK6 Gr kvt)'FINc V Llb4 hA VA nuistJ. ► GOOD MNUITIUN V r � IVY OVEA313 exces8IY@ SOLID$ L ACHF18LO KUNfiA�:r, SOL M CA KA Yo YUP�. ODED �x p LA I t,° l'VMM�NT� 1 , / •�,. CIIUSet�S ' + MASSACHUSETTS ORTH�ANl�'OVER s SY TQMPump�ngAdcor' t��i-}� 1tJ J1.7tJ �I�/ ! ... • .? ,�('nil •!'�+ t,�it, .i` tf S,�:J��;y111 r�L(. 1- . . .. - :;' DEP has provided thls form for use by local Boards of Health. The S stem Pumn must be submitted to the Iocal'Board of Health or other approving authority. RECEIVED A Facility Information . + �� tmRortant. JUN 4 2007 +„When filling out 1 : System Location fOr�u Ott the'; TOW JF N!�RTH ANDOVER Computer,Use Tri DEPARTMENT ony the tab key Address to move your: j__ G �11� cursor•do not U34 the return Clty/Town State V p Code System Owner, Name' r l� Address(If different from location) CltylTovm State piCode Telephone Number Pu ping Pur R} e` cord. Da. . f Pumping ' Date 2. Quantity Pumped; -- Gallons 3, 'Typ@ of system ❑ Cesspool(s) Septic Tank ❑ Tight Tank Other(describe); 4 Effluent Tee Filter present?.❑ Yes If yes, was itcleaned? ❑ Y No tit +f ,`t.1 � + r�•1 +r 5 ConditJon of Syst m' ..(. ' P.J. .+++x;tt(�,�.,. , ..jy,:,`ti$1 K i { 1• 8 Sy Qi Pumpedhic By ` 1 {{,�FFF�Jama i'•r r ,:, . i ,,,ti J.,. ,c.. / YehhIcIe,U/ccen#e 1 4 t .r• L�ri��tf'zy l,�•.}�: .YtAY t�.��`�` 1#II 'i .- \/-• •t' VI /�/// Number t it Yt•• art TY'.NY,ir yJj' �.� //I J �✓{ ' yiy '+ w.� com�y,y,•,,,,,� �rt It6♦}y}l�{"fl r�iiY( ,( rlrt f .. •y� +.� Hritl�lk tywJ � LYr.�: ti•"at; - +• .. ., - , d ' r f' :,7 Location where,contents Were disposed; Slpnature OI Hauler:,} ,;u;c. , Date http://www.Mas's.gov/de�htiiafeNapprovals/t5forms,h tm#Inspect t5forrn4.doa 06103 System Pumping Record•Page 1 of 1 APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application fob a permit for a sewage disposal installation at �-7 AV- - '�C . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of oZ 67_9 lineal (square) feet of effective absorption area. The pipes will be laid on. a 6 inch layer of washed gravel or crushed stone ranging g in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply., 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit _Plot Plans must be submitted with application. DATE Si atureF of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signature �f Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature flispecting Offi'ear Percolation Test'/fit .; J � Garbage Grinder r A BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. q, -7 -fie ld �s cOrGa �56o�Sa� S �o.� 78,900 pt ?G .3 /5 d• l3 / -7-3, � �9 1. NAME �-G�i r9� Q'Y/'' DATE / 2 - 70 2. ADDRESS #��(�D cSQ rsZ s LOT NO. TEL. -S-170 3. NO. OF BEDROOMS 3 T DEN YES NO 4. GARBAGE GRINDER YES V NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL DATE q �O NAME OF APPLICANT LOCATION O Address of lot no, BUILDING: Dwelling X Other SYSTEM: New DC Repair GENERAL DESCRIPTION OF LAND SUBSOIL: Clay avel Sand PERCOLATION TEST minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK dam.-) gallon capacity. LEACH FIELD off? lineal feet of drain pipe, n William J. qrlsEoll , Engine r Board of Hea h S' } TbWN OF NORTH AIiDOVFR:: x. SYSTEM P'UM-PI.NG [ . COR. _ UWNI,R & AUDR1?SS «. SYSTEM LOCATION --`— (Mmple: left fronl-oFhousr) "'T OF PUMPIN.C, � \b QUANTITY f UMPC ods LL c» , 00L: NO YES SEPTIC TANK: NO YES t/ X -\TUKE OFSERYICE; ROUTINE. ,_,„ EMERCEN'CY t1IISPRYAT10NS. . CO OD CUNllITION... F'ULLTO COYCIZ Hr-.AYY C,REASC,. .BAFFLES IN PIACI: ROOTS. '' LEACHFII?LD IZUNL3AC'K... CXCESSI•YE SOLIDS FLOODED SOLI DS-CA RRYOYER .(J�HFR.(EX%A.IN) >>'>'I'L'M PUM (CD RY L u 11'vl f:NTS: uN'I' TIzANSPC, I Z R S 0 TO ..� ' ' EIVED '`�'��'�,' ,ti 0�', r ��j,�;'r/rrIrLl�•y �;•�.,',R 6,C 0 rd " . s E - Krr, �ii IY TOWN 017 NORTH ANDOVER �Q�P,hit I Yldtd ;.Illy/orrn ror „ r HEALTH DEPARTMENT Boer p .bnllllOdllo V11 locrl 8crr4r � r ,00lln^or clnarcllp�rro,ulr :. ''''o S C I .Inoriry A' Faclllty Inlorrrl�(ion .'.1 '.'.111;lJi ^.• 111 �� \\�C�O/�„f",,-' � 1;1�,'�;'DIY'�l(���'i�l,'r' '�'i�'���9iCJ�'Y''', ,'�, •• „%'� ' �IIII ----�_" I '1 r'y.,�' '',i+'y'tl�i,pl✓.'INr��'I`4 J �I�,ri/;•; 1 .� '''rVdrNr—77,77 ranbu'Vonl • �4�c,•n .. yp• ` IL 92 ' � ',� ;81YPumping•�e��ord ♦ ,� 'I' 'I{i'I��'�.rr,r,'yll l;Y! Irl�I� + , I. OaleofPvmpinp•i•' i r.. 01;1 ',,� �• " �',� '1'ype�41 �yll�em,`�;' Q Ca>>�ool��� r• -r ,Id ' (de scribe1,� n mY T , ��)'r,9/4f�llll(' �(p„3enr? C Yoe .; , ;;,;%' `;I�`�'S�y''!'�''�'1,�,1''u,"G�i,l'�)�?�;N'4,rls',�•. , � reg. „el �� craane0� ', .. . , : '�'��'„..;�B�,;I;C'Q/iv y9nl pG',�y,,• �ti.,�r,r,�, : -- < '' — • .-'�/� 7�•I 'l, i!I�' I waw r � T Syi ;NPVTP 1',i1; . •. �, ,,I,���y;'+/�(� 1 `•%�' ,�I'l�' {� 1;(�, 1 ' �y'•' r Y{ItIU{ 'Joenl I n'',•^�(r rel: / on.wher! ,' I,ur,lll�,! •�r,, v, Ibl , J,0 dhP039o; porldeP'*eleilipp(oYi/�Iblorm�,r;npin Irl, •' �;�, t �; r IWR:TrMASSA•CrHUSETT�S ? ecoid ',j f.Y,,`, •� v �,ox;'11'I :r���Jj`1/.1�,ty��rt'I„ 'Y��1'fl ill..r.:•'•' � � - ' ' dt'avtl VY.{+�Fll tt'�/,K�rW 1 I, Y 1.A:,•(, 'I G„•n.li'�1'� t �a,.r,!.t({i•. ! '�",'1'C'rF y1F'1•'•I. F:vw,v(':i;��•,.•.�. ., '� ., •, DEP..h&s proVfded jhls (orm for use by local Boards of Health, The System Pumping be submlt ,Q, o'the.loca1 80ard of Health or other approving authority, A;. Facility .lnforr ,atlon '�r:Tw�r�9 out� .,i'..' S�ystem1•Locatlon;�� only the tab koy w move yow.: L44lh1 rj Myr' „: ;:;.Clty/Tvwn / y„ , p1 ,.�'�','; i;!t,{,.l!,., i'�• ..:,� ,,; Stats .r :',�., � w•t�,,�J,'J; :•. �+ 1,Y�.,�,; r 'i: Up Code ;1:.;.MY'i�.J��`k yfa�,1�t..i. !t:•V $` � .+•;v.l;,'�'; ,, :I: .,r ,11 r";.;2' r• �., am Owner:1 ..•F '' �� I . .l '► YL ''';" ,rrt,)•`I r.r•.i,�:F,. •.,•: is N�� ,JQ.i'iy' I'..�.•7•,t l'�,i!r: '..v,.(... .r Addraai(If dlHennt rom Iota' G77 Uon) R. r, r Stale rLo n !a 1$ laphone Numbor it (,1f.V C•Y It(•`�,.�'1�':��.'.t','" ' • O" '- Pumping:Ragord i N 1�L/'•'I \-� � •,'•�. �� I F'1Date oI Pumping' � Quanu P � dole 2, ry umped: -3 .,"TYP9 P�.ayslem;, ' ❑ Cesspool($) S tic Tank p ❑ Tight Tank 10 (descrlbe�; `- . ,:4 EHieril Tag FlltrQ' r• e Cl Yes o If t' t ,�tit11 p tN•ri'. •i'��;,CiPi 1 ,`' yes, Was II Cleaned? CD yes ❑ No ' � .,. ..t... ,.;rte.'..�y,.J ..�,a'`���ii�•,.r:Sr!'L r: IuJt�r�•,' 1�, :If( �!)I�YJ'f,l'f r•7 idr:f, I' i�� Yy�'r:. - ' l I't :, J( I),��.r;il•i:,,f1i,'.'L�trJ�'t'{ �`' � ' r� , JF• (1 J J •, t t,, t � J/ yll�l.�t�.,,jl l:/ 1 } I �,} Wrki� ,r� l�,,t';•'�: ,, VehlcJ e Ucen e Numbier ;�r;'Skt';1�}�r• • ,Y.J�::i• .�l;l'• ''ifi� '�(r :S7� ,�,.�,.J ,�y�� moi•,1,�'� '.i•iy(�'l1 i�t'���li''• "'Y4 ;i, r r r �. �. ''r''' 1.'N����'ri�:iflrr�,+•r•'�jJ�rffi�it�t�l �}'•�j.�Y:v(NI;�I:I��l,1�Jl����,���fit i' I �� on,where o e i c l n is e re' .;•': ';•<: '7=,'.;/'r`t>.,;: r �, !1 ,W... dl�posed, ..� ,r � r tJ .rp r,• , ��CCJ7 (j(,(�f �. � '.;�.rr.-�'��',,1•,i'.IJ"'•;r'•,'. 7{;;i.l i7!';}.;f.t�'� ' .•i!'t,tv�t y',r�����}f•����i':::Y,;(., • ,. SI!Y ; .'Jreli�;.'rrt�lfJi(�•��.'.•t���:,:r• 'Y.151.i � � � � + #two o aide h4)Av",massrgov/dap!iveler/approvaJs/t6(orms,htmAlns t�fcrrrA doc,''�pJ ''.. 4. Syilem Pumpinp Recoro —C\-N Commonwealth of Massachusetts City/Town of EcIVE13 System Pumping Record ,J ?�8 call Form 4 TOWN OF NORTH ANDONT R DEP has provided this form for use by local Boards of Health Otti5 , 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the (OD nn computer,use 115 only the tab key Address to move your North Andover ma 01886 cursor-do not Citylrown State Zip Code use the return key. 2. System Owner: ii^^ Name Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 13 L� 1. Date of Pumping pate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: a 1j 6. S stem Pump y: Name Vehicle License Number Stewart Septic Service Company 7. Location where contents were disposed: §*arts Pre treatment Plant 20 So. Mill St, Bradford Ma 01835 Sig re of Hauler Date Signature of Receiving Facility Date t5form4.doc-03/06 System Pumping Record•Page 1 of 1 i i [i I Commonwealth of Massachusetts Cit /Town of No andover 5. System Pumping Record Form 4 M i 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. Syste i on the computer, use only the tab T���n key to move your Address cursor-do not No Andover � Ma use key the return City/Town State Zip Code 2. System n a Name rerun Address(if different from location) JUN L 1 ZUJ CitylTown State HEALOTFWDEPARTM NT%ANDOVER Telephone Number B. Pumping Record G 1. Date of PumpingDat r , 22. Quantity Pumped: Gallons � 3. Type of system: ❑ Cesspool(s) eSeptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes671\10 If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service I Company 7. Location where contents were disposed: Swart's P e-treatment Plant, 20 So. Mill Bradford, Ma 01835 ignature H uler Date ign re Receiving Facility Date i t5form4.doc•03/06 System Pumping Record•Page 1 of 1 No Andover J&S Development dba 1600 Osgood St Stewart's Septic Building 20 Suite 2-36 Andover Septic No. Andover, Ma 01845 58 South Kimball Street Bradford, MA 01835 �F�s ' Date Name_ & Address Gallons Comments "�-N 1-Mai Patter reality 81 Sawmill Rd 1600 Good TC�bVN Car-NOUH ANDQ\At.R 2-May"Mulcaliy650 Sharpners Pond Rd 1500 Good HEALTH DERARTM. NT 1,. Q �Greene 62 Willow Ridge Rd 1000 Good 3- R May'Lacros 259 Grandville 2500 Good 4-May �nc8hn 115 Sherwood Dr 1500 Xsolids HG 9-May�Callahhn 940 Foster St 1500 Good 10-Ma' Melerim 1444 Salem St 1500 Xsolids 15-MayzDiraff3fi Brenkin ridge Rd 1500 Good N t6epari,175 Stone Cleave Rd 1500 Good 16-May Martin 701 Forest St 1500 Good " IMurphy16 Carleton Lane 1500 Good 18=May G d-erg of,267 Old Cart Way 1500 Good ,Solano`21.98 Tnok St 1000 Rh 21-Mayi-omichZ 115 Laconia Cir 1500 Good Reti 42 Cross Bow / 1500 Good 24MayCarbane°II 1560 Salem St 1000 Good 29-May Thurber 210 Farnum St 1500 Good (31`May Cleary�fil0 Winter green Dr 1000 Good i