HomeMy WebLinkAboutApril 2025 Bake N Joy - Septic Pumping Slip - 351 WILLOW STREET 5/2/2025 tv,I
Commonwealth of Massachusetts 0-f NOdh ver
C,ity/Town of No. Andover
MAY 225
System Pump"Ing Record
Form 4
D
D,E,P has provided thi's form for use by local Boards of Health. Other forms may be seClq, 0q0t
information must be substantially the same as that provided here. Before using this form, check with yolur
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 CM R 15.351.
A. Facility Information
Important,When
filling out forms 1. System Location:
on the computer,
use only the tab
key to move your Address
cursor-do nolt No., Andover 01845
use the return
key. City/Town State Zip Code
2. System Owner:
%0Q f
Name
Run SAME
Address(if different from location)
City/Tolwn State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping y P
Date 2. Quantitumped: Gallons ..........
3. Com�ponent: El' Cesspools) El Septic Tank Tight Tank Grease Trap
01"/07 14
`other(describe): ........
4., Effluent Tee Filter present,? El Yes, � f4o If yes, was it cleaned? E:1 Yes, 0 No
5. Observed condition of component pumped:
All of this estimated
information is non-bindling, valid only at the time of um ing. Not s ond the date above.
re b�y
6. System Pumped By:
dI
..............
4ame Vehicle license-- lumber- -—-—----------------"--
J&S Development Corp. dl/b/a Stewart's Septic
Service
7. Location where contents were disposed:
Stewart' °Recpiving Facility, 20 So. Mill St., Bradford, MA 01835
JI00-
...........�;.
S I�pu' „.,�' a'.,w,r III r�'" e e a bove ?
Signature of Hauler Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doce 11/12 System Pumping Record Page 1 of 1
Commonwealth of Massachusetts Tow,
Of Nofth Andolver
City/Town �v,er
C7
System Pumplmng Record
MAY
Form 4 5 2025
Af &N*
DEP has provided this form for use by local Boards of Health. d4awr"i�s '*qq*bAVh 0
i c
information must be substantial�ly the same as that provided here. Before u ng k 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 t he tab
key to move your Address
cursor-do not No. Andover MA 01 8�45
use the return
key. City/Town State Zip Code
60
2. System Owner:
tab
Name
SAME,
..........
Address(if different from location)
...........
City/Town State Zip Code
Telephone Number
Pumping Record
1. Date of Pumping 2. Quantity Pumped:
Date Gall11 nis
3. Component: Cesspool(s) E] Septic Tank El Tight Tank E] Grease Trap
1.101,
Ej Other(describe}:
4. Effluent Tee Filter present? El Yes E9 o If ye�s, was it cleaned? F-1 Yes 01 No
5. Observed condition of component pumped:
All of this es,t,imated
information is non-b n , valid only at the Ve of pumping. Not,responsible beyond the date above._
6. System PU e By:
....................
Name Vehicle License Number
J&S, Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were di�sposed:
,Stewart's Re wing FacilLity,20 Spmill St., Bradford, MA 01836
See abo�ve
..........
19 relf Hauler .Date
See above
............... ...........
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doco 11/12 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts TO of Nofth Andover
C"Ity/Town of No. Andover
System Pump"Ing Record MAY 5 2025
Form 4
At
C_
DEP has provided this form for use by local Boards of Health. Other for'm;s`Jm'6`yT' bePu9gn
I
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
Implortant:When
filling out forms 1 System Location:
on the computer, �V
use only the tab ...... ........ ....
key to move your Address
cursor-do not No. Andover MA 01845
use the return key. City/Town State Zip Code
2. System Owner:
lb Qi,�o
Name
SA M E
Address if different from location)
..... .............
City/Town State Zip Code
Telephone Number
B. Pu mp"Ing Record
L(
1. Date of Pumping Date 2. Quantity Pumped: Gallons .. _�.
I Component: Cesspool(s) El Septic Tank El Tight Tank Grease Trap
IA
E/Other(describe): .........
4. Effluent T'ee Filter present? El Yes No If'yes, was it cleaned? 0 Yes E No
5. Observed condition of compo, ant pumped i
All of this estimated
-information is non-!!qjncl 9, valid o t the Ve qj_pymping..Not res onsibl'; beyond the date above.
6. System P ed By:
...................
Na Vehicle License Number
J&S Development Corp., d/b/a Stewart's Septic
Service
............................ ..........
7. Location where contents were disposed:
-.Stewart's Receiving Fapilit20 So. Mill St., Bradfordi, MA 01835
See above
ur a Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doco 11/12 System Pumping,Recordo Page 1 of 1
Town of Nord h Andover
Commonwealth of Massachusetts
City/Town of No AndoverMAY 2025
System u e c rd
Form 4 t
t
:r c
Depaftment
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
failing out forms 1. System Location: 7
ti
on the computer,
use only the tab
key to move your Address
cursor-do not
use the return City/Town State Zip Code
key.
t�
2. System owner:
Name
Address(if different from location)
No Andover MA
City/Town State Zip Code
Telephone Number
B, Pumping Record
00
li5l
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: [❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap
0 other(describe):
4. Effluent Tee Filter present? El Yes /Nco If yes,was it cleaned? F-❑ Yes ❑ No
5. observed condition of component pumped:
K.q
6. Sy temp piped B
+ r
Name Vehicle License Number
Stewart's Septic 58 So Kimball St. , Bradford,MA
Company
7. Location where contents were disposed:
20 So.Mill t.,Bradford,M
t e Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc■11/12 System Pumping Record•Page I of 1
Town of NOdh Andover
Commonwealth of Massachusetts
Z N'PA City/Town of No. Andover
V
MAY
5' 2025
System Pumping Recoirdi
% Form 4
171Cr-')Ith D r
DE,P has provided' this form for use by local Boards of Health. Other forms may be usec PUut t
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 3101 CITE 15.351.
A. Facility Information
Important:When
filling out forms, 1. System Location:
on the computer,
use only the tab 351 Willow Street,
key to more your Address
cursor-do not No. Andover MA 01845
use the return
key. City/Town State Zip Code
it ctab 2. System Owner- Bake'NJoy
Name
RUM
SAME
Address(if different from location)
CitylTown State Zip Code
Telephone Number
113. Pumping Record
7,_17, �(111 jK,,)
1. Date of Pumping ............--- 2. Quantity Pumped:
Date Gallons
3. Component: Ces,spool(s) El Septic Tank El Tight Tank Z' Grease Trap
00
.......... Sludge
Other(describe):
4. Effluent Tee Filter present? El Yes If yes, was it cleaned.? [:1 Yes El No
5. Obse,�rved co9dition of component pumped:
10 SLUDGE All of this estimated
Jnformation is non-binding, valid, onl.Y-at the time of pumping..Not responsible be and the date above.
6. System Pumped
"07
0#)
.........�10
Name Vehicle License Number
J&S Development Corp. d/b/a Stewart's, Septic
-Service —................
7. Location where contents were disposed:
Stewart',� Receiving Facility, 201 So. Mill St., Bradford, MA 01835
-........
See above
7 "",_I
Signature of'Hauler Date
See above
S,ig
...... ....
i,nature of Receiving Facility(or attach facility receipt) Cate
t5form4.doc*11/12 System Pumping Record Page 1 of 1
7
Commonwealth of Massachusetts Otlln Of*
Andover
NO City/Town of No. Andover
System� Pump�l"ng Record MAYa.
5 2025
% Form 4
Af -4'5
DE P has provided this form for use by local Boards of Health. other forms may
,,QePartment
information must be substantially the same as that provided here. Before us,inig 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 CIVIR 15.351.
A. Facility Information
Important:When
filling out forms 1 System Location:
on the computer,
use only the tab 351 Willow Street
key to move your Address
cursor-do not -No. Andover MA
use the return 01845
key. City/To,wn State Zip,Code
2. System Owner-,
Bake 'N'_4_W
Name
run
SAME
Address if different from location),
Ciity/Town State Zip Code
Telephone Number
B. Pumping Record'
�?Y
1. Date of Pumpi ng
Date 2. Quantity Pumped:
Gallons
3, Component: Ej Cesspool(s) El Septic Tank El Tight Tank Grease Trap
Ej Other(describe): flu
4., Effluent Tee Filter present? Ej Yes No If yes, was it cleaned? El Yes E:1 No
5. Observed condition of component pumped:
information is non-bindi'n , validSLUDGE All, of this estimated
only ly at the time of in Not responsible bond the date above.
6. System PuT ed
-Name
Vehicle License Number
J&S Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were disposed:
Stewart's Rece' Facilit 20 So. Mill' St., Bradford, MA 01835
00 p0li
00
Igil
See above
nature of Hauler Date
See above
Signature of Receiving Facility or attach facility receipt) Date
t5form4.doco 11112 System Pumping Record Page 1 of 1
Town OfNoilh Andover
Commonwealth of Massachusetts
5
MAY 1825
City/Town of No. Andover
System Pumping Record
01 Form 4 Departm,0%AM&
Af Is 0 V"t
DEP has provided th�is 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 data in
accordance with 310 CM R 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab -—------- 351 Willow Street ...................
key to move your Address
cursor-do not No. Andover MA 01845
use the return
key. City/Town State Zip Code
00
2. System Owner:
tab:L9 Bake Jjo
Name
SAME
Address(if different from location)
...........
City/Town State Zip Code
Telephone Number
B. Pumping: Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons-"""-""
3. Component: Ej Cesspool(s) Septic Tank E] Tight Tank E Grease Trap
u �e
El Other(describe): Sl
4. Effluent Tee Filter present'? El Yes a,"No If yes, was it cleaned'? F1 Yes El No
5. Observed c dition of component pumped:
SLUDGE, All of this estimated
information is non-blinding,valid only at the time o�pump s 99 ible beyond the date, above.
6. System Pumped By:
..........
Name Vehicle License Number
J&S Development Corp., d/b/a Stewart's Septic
Service
7. Location where contents were disposed:
Stewar'," Receiving_faci'lity, 20 So. Mill St.,, Bradford, MA 01835
_ .....m0, WW
See above
.................
Signature of Hauler Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc*11112 System Pumping Record Page 1 of 1
J1,1i North Andover
Commonwealth of Massa chusetts
t o. Andover MAY 5 2`02�_ mm
Z
>
System Pumping Record
4.'I
,
Form 4 4 1, 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 ng Record must be submitted to
the local Board of Health or other approving authority within 1'4 days from the pumping date in
accordance with 310 CM R 15.351.
A. Facility Information
Important:When
filling out forms I System Location:
on the computer,
use only the tab 351 Willowstreet
key to move your Address
cursor-do not No�. Andover MA 01845
use the return ..............
key. City/Town State Zip Code
%",01116 2. System Owner: BakeN'_Joy
Name
SAME
...........
Address(if different from location)
...........-
City/Town State dip Code,
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons lez
3. Component: Ej Cesspool(s) El Septic'Tank Tight Tank Grease Trap
000
Lo,
-ooF Slu e
j jo
UT/ether(describe): ........
4. Effluent Tee Filter present? [:1 Yes EgeAo If yes, was it cleaned? Yes [:1 No
5. Observed coqq'1jtion of component pumped:
SLUDGE All of this estimated
information, is non-bindiqq,...,,va.lid only at the time of pumpitjqdot re�n�ible beyond the date above
6�. System Pumped By:
le'07
__0 ".7o
v/P""01
0
Z 00,
_.I .............
Name Vehicle License Number
J&S Development Corp. d'/b/a Stewart's Septic
Service
7. Location where contents were disposed':
Stew r R iv in Facility, 20 So. M'ill St., Bradford, MA 01835,
.-or..............
I... ............
See above
Signature of Hauler Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doce 11/12 System Pumping record Page 1 of 1
Commonwealth of Massachusetts GfNOrth Andover
City/Town of No. Andov-_
er
MA
System Plumping Recoiu y 6,2025
Form 4
�Q dM
MCP has provided this form for use by local Boards of H'eal'th. Other forms�"MM I wit
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 aplproving, authority within 14 days from, the pumping date in
accordance with 310 CIVIR 15.351.
A. Faci lity I nformation
Important:When
filling out forms 1 System Location:
on the computer,
use only the tab 351 Willow Street
key to move your Address
cursor-do not No. Andover MA 01845
use the return
key. City/Town State Zip Code —---------------
lab 2. System Owner:
yakeN' Jo
Name
SAME
Address(if different from location)
City/T'own State Zip Code
Telephone Number
B. Pumping Record
q
1. Date of Pumping, Date 2. Quantity Pumped: ..Gallons .........
3. Component: Ej Cesspool(s) El Septic Tank El Tight Tank Z Grease Trap
Stud
zz',e 7l le
..............
2`00'Other(d'escribel):
4. Effluent Tee Filter present? I 'es o If yes, was it cleaned? Ell Yes Ej No
5. Ob rvedcondition of c mponen pumped:
e,
SLUDGE All of this estimated
ly
information is non-binding, vai onl at the time of pu Not s qnsible n
T Rog the data above.,
6. System Pumped By:
Name Vehicle License Number
J&S Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were disposed:
^ e%
Stewart" eceivinul Facility, 20 So. Mill St., Bradford, MA 01835
-`Va 40Aoar
el See abovedM
Sig natu re of Ha,uler Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doce 11/12 System Pumping Record,#Page 1 of 1
&l
Commonwealth of Massachusetts 1011111 Of iNorth Andover
C*ty/Town of No. Andover
System Pumping Record MAY 5,2025
Form 4
be e
D
DEP has provided this form folr use by local Board' forms s of Health. Other foray m 049,qM"t
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 Plumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping data in
accordance with 310 CM R 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab _...._._� 351 Willow Street
key to move your Address
cursor-do not No. Andover MA 01845
use the return City/Town ...... State Zip Code
key.
2�. System Owner:
Bake '-N' Joy
Name
Un tow SAME
----------
Address(if different from location)
City/Town State Zip Code
....... . ................Telephone Number
B. Pumping Record
1'. Date, of Pumpi ng .2 Quantity Pumi ed:
Date Gallons
3. Component: El Cesspolol(s) F Septic Tank El Tight Tank Z Grease Trap
��] Other(describe).,
SI..Udge
4. Effluent Tee Filter present? El Yes No If yes, was it cleaned? E:1 Yes [:] No
5. Observed condition of component pumped:
SLUDGE All of this estimated
-information is non-binding, valid qnly_�t the time of purn Ping. Not responsiblebeyand the date above.
6. System Pumnnd B"*
Name Vehicle License Number
J&S Development Corp. d:/b/a Stewart's Septic
Service
7. Location where contents were disposed:
Stewart's R&ceiving F ility, 20 So. Mill St.,, Bradford, MA 01835
See above
:at auler Date
See above
S,i'gnature of Receiving Facility or attach facility receipt) Date
t5form4.doce 11112 System Pumping Record Page 1 of'l
n
Commonwealth of Massachusetts 4,1 Nofth Andover
City/Town of No. And over
Systeml Pump"Ing Record MAY 6,
Form 4
DEP has provided this form for use by local Boards of Health. Other forms mayy us' �Qfte t
1q
information must be substantially the same as that provided here. k w
Before using this form, checit' 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. it Information
lrnportant�When
filling,out forms 1. System Location*
on,the computer,
use only the tab 351 Willow Street
key to move your Address
cursor-do not -No. Andover NA 0 184 5
use the return key. City/Town! State Zip Code
tab 2. System Owner:
....... Bake 'N" Joy
Name
SAME
Address if different from location)
....... ......
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping, Date 2. Quantity Pumped: -Gallons ...........
3,. Component: r] Cesspool(s) E:1 Septic Tank Ej Tight Tank E Grease Trap
S 11 u d
Other(describe): ..........
4. Effluent Tee Filter present?
Yes No If yes, was it cleaned? E:1 Yes Ej No
5. Observed condition of component pumped:
SLUDGE All of this estimated
-information is non-binding valid only at the time of pumping. Not responsible beyond the date above.
6. System Pumped B
oe Narne Vehicle License Number
J&S Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were disposed:
..Stew,,)rys Receivin Facili 20 So. Mill St., Bradford, MA 01835
NJ See above
Sign at ure of Haule r Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doca 11/12 System Pumping Record a Page 1 of 1
Commonwealth of Massachusetts Town of Nod Andover
y n of No. Andover
MAY 5 2625
System Pumping Record'
Form 4
tq
Ai
t
CHEF' 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 31'0 CM'R 15.351.
A. Facility Information:
I'm portant:When
filling out forms 1 System Location:
on the computer,
use only the tab 351 Willow Street
key to move your Address
cursor-do not -No, Andover MA 01845
use the return ............- —
key. City/Town State Zip Code
116 1 otab 2. System Owner: fake 'N' Jo
Y_
Name
-SAME
Address(if different from location)
CityiTown State Zip Code
Telephone Number
B. Pumping Record:
I. Date of Pumping 2. Quantity Pumped:
__..._
Date Gallons
3., Component: El Cesspool(s) F1 Septic Tank El Tight Tank 0 Grease Trap
E Other(describe): Slud%e
4. Effluent Tee Filter present? E] Yes 2"O�No If yes,, was it cleaned? Yes, 0 No
5., Observed condition of component pumped.
SLUDGE All of this estimated
information is non-binding, valid op�y at the time of umping., Not rpspq�sible b��yqnd the date above.,
6. System Pumped B,
(_9
.. ....... ......... .........
Name Vehicle License plumber
J&S Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were disposed:
St's Receiv� 5tewpr � a 0 , B d, 0
I..�_.� ....�.. I'll 11 ..................
See above
_..._.. _ _........................
Signature of H uter Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4,doce 11112 System Pumping Recordo Page 1 of 1
Nlod Andover
Com monwealth of Massach usetts
U I MAY 5,ZOI25
"Ity/Town of No. Andover
z
Sys te m mpi ng Rec o rd
Form 4
Af .).9partment
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 CIVIR 15.351.
A. Faci l ity Information
Important:When
filling out forms I System Location:
on the computer,
use only the tab 351 Willow Street
key to move your Address
cursor-do not No. Andover MA 018451
use the returnCity/Town ____ — I .........
key. State Zip Code
2. System Owner:
tab
lbok] Bake 'N" J
I Name
SAME
Address if different from location)
City/Town State Zip,Code
Telephone Number
B. Pumping Record
0 0
1 Date of PIumping -Date 2. Quantity Pumped: Gallons
3. Component: El Cesspool(s) Ell Septic Tank Tight Tank Z Grease Trap
0 Other(describe): S I u
4. Effluent Tee Filter present? E] Yes [2/No If yes, was it cleaned? Ej Yes E] No
5. Observed condition of component pumped:
SLUDGE All of this estimated
information is non-b!pqjpg, val�id,on! the time phi mot�res�qnsible.be oqd the date above.
6. System Pumped By:
uld".1-f-:Lc
Name Vehicle License Number
J'&S Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were disposed.:
Stewart's Receivina Facilit 20 So. Mill St., o MA 01835
t ........ Y1Bradf rd
See above
e aul:er Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.docs 11/12 System Pumping Recordo Page 1 of 1