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Home My WebLink AboutJune 2025 Bake N Joy Grease Trap - Septic Pumping Slip - 351 WILLOW STREET 6/13/2025 To Wn Of.North &ft rhA d, Commonwealth of Massachusetts over City/Town of No. Andover Juts 20,1 System! Pumping Record 0 % Form 4 Af vepa DEP has provided this form for use by local Boards of Health. Other forms may be used, but nt 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 purnping date in accordance with 310 CMR 151.351. A, Facility Information Important:When filling out forms 1, System Location: J on the computer, use only the tab .................... ((0 t'lf key to move your Address cursor-do not No. Andover MA 01845 use the return key. City/Town State Zip Code 2. System Owner: t8h Name SAME Address(if different from location) City/To n State Zip Code Telephone Number B,. Pumpling Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Component: El Cesspool(s) El Septic Tank E] Tight Tank [:1 Grease Trap e-S L - "I Other(describe): / w 4. Effluent Tee Filter present? F-1 Yes P'No If yes, was it cleaned? [I Yes El No 5. Observed c ndition of component pumped.- A All of this estimated information is non-binding, valid only at the time of eyqqd the date above.,__ 6. System Pumped By: C.-001� 0-10 Z_*- ...... .............- Name Vehicle License Number J&S Development Corp. d/bi/a Stewart's Septic Service 7. Location where contents were disposed: ,Stewart's Receiving Facility, 20 So, Mill St., Bradford, M,A 01835 �j See above Signature of Hauler" Date See above Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc,l 11/12 System Pumping Record Page 1 of 1 I own Andover Commonwealth of Massachusetts JUL 8 2025 City/Town of No. Andover System Pumping Record h0clilth Depcjrtme At Form 4 t 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 I nformation Important:When filling oust forms 1. System Location: on the computer, 3t;1 VV// v ,d use only the tab key to move your Address cursor-do not N use the return - o. Andover MA—..-.. 01845, key. City/Town State Zip Code I 2. System Owner: A Utab Name Won 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) 0 Septic Tank Ej Tight Tank El Grease Trap 0 4,-,00 Other(describe): 4. Effluent Tee Filter present? 0 Yes 92o"No If yes, was it cleaned? Ej Yes E] No 5. Observed c^ndition of component pumped: All of this estimated information is non-,binding, valid only at the time of pumping, Not re �onsible 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: -Stewart's Receiving Facility,..ZO So. Mill St., Bradford, MA 01835 See above ............. Signature of Hauler Date See above signature of'Receivinig Facility(or attach facility receipt) Date t5form4.doco 11/12 System Pumping Record Page I of I I -0 C)f JV Commonwealth of Massachusetts City/Tow,n . Andover System Pumping Record jut Form At -4 D P has provided this form for use by local Boards of health, Other forms ma'y�Ngfi information must be substantially the car e as that provided here. Before us,in this f yMyyour rmp Ve I local Board of Health to determine the form they use. The System Pumping Record must be submitted t the local Bard of Health or other approving authority within 14 days from the pumping date in accordance with 31 CAR 15,351. A. Facility Information Important:When filling out forms 1. System Location. on the computer, use only the tad key to move your Address cursor do not Nth. Andover MA1 45 use the return _. key. City/Town State Zip Code.._ 2�.. System Owner. .. IOUr Name NOW f -SAME Address(if different from location) _____... �m _..... �....._ _._�.... City/Town State Zip(rode ....... _.�._.._.._.m_. _....._ Telephone Number er B. Pumping Recoird ........... ................. ,,. "(1 100, 1. Date of Pumping _.�_m .._M..__ ....._�... .... 2. Quantity Pumped. _.._.. Date Gallons . Component.: Cesspool a Septic Trask Fight Tank � Grease Trap Other r(describe): 4. Effluent Tee Filter present? El Yes No if yes, was it cleaned? El Yes No 5. Observed condi ion of cornpo nt pumped. lop Al:l of this estimated i'nformatio, is n lindinlg, valid ony.at the time of pumping. Not re§tensible old the date ,above 6. System �it ped o Name Vehicle License Number J&S Development Corp. d/b/a Stewart's optic Service f. Location where contents were disposed. %lit 2 So. Mill St., Bradford, MA 01836 d �mell, See above Signature of Ha# U1er 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, Town Of North Ando City/Town of No. Andover JUL 8 2025 Sys,tem Pumping Record S Form 4 Hed/th %J'b UepartMent 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 ap�proving authority within 14 days from the pumping date in accordance with 31'0 CM R 15.351, Facility Ind O' rmation Important:'When filling out forms 1. System Location: on the computer, use only the tab —....... 4 key to move your Address cursor-do not No. Andover MA 01'845 use the return key. City/Town State Zip Code tab 2. System Owner: Name SAME Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumpling 2. Quantity Pumped: ........ Date Gallons 3. Component.* Ces's'p eel(s) Septic Tank Ej Tight Tank E] Grease Trap .gjloo`�Other(describe): 4. Effluent Tee Filter present? E] Yes a.1<0 If yes, was it cleaned? El Yes E] No 5. Observed co, tion of component p,umped.* All of this estimated -information is non-��iding, valid qpy_�t the time ofPyTpklig--.. Not r�§pqnsiblt_beyond the date above. 6. System Pumped By: %Wool Name Vehicle License Number J'&S Development Corp, d/b/a Stewart's Septic Service 7. Location where contents were disposed: Stewart)rReceivin Facility, 20 So. Mill St., Bradford, MA 01 35 Ov 0011- See above 2a Signature of Hauler Date ......... See above.--- Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc,, 11/12 System Pumping Record,,Page 1 of 1 f Commonwealth of Massachusetts Town of North duver City/Town of Andover rV System Pumping Record JUL 8 2025 Form 4 DEb has provided this form for use by local Boards of Health. Other forms may VP P � he information must be substantially the same as that provided here. Before using this form, o &ith your local Board of Health to determine the form they use. The System bumping 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 farms 1. System Location., on the computer, ��1 'willow tree' use only the tab �.. _ .�. �_..._._ __...... t key to move your Address cursor-do not No. Andover MA 01845 use the return .... _. �. key. City/Town State Zip Cade tab �. SystemOwner: ._._._.._._...._ _.. .. _... _..._..._._. fake N N' Jam..... Name EM SAME Address(if different fr�._.. . ___... . .... ..._.....W� ..._. ........n em location) ...... ___ __...M.. .. . City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping __.. 2. Quantity Pumped: " � Cate Gallons 3. Component: El Cesspools Ej Septic Tank Ej TightTank Z Grease Trap F1 Other(describe): ___m_. _.._ __ Sludge 4. Effluent Tee Filter present? [] Yes No If yes, was it cleaned' 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 respons,ible beyond the date above. . System bumped y: Name ._.. Vehicle License Number J&S Development Corp. d�/b/a Stewart"s Septic Service '. Location where contents were disposed: Stewart's Deceiving F,agili�, ��0_ITITSo. Mill St., Bradford, MA 01835 O'so� � ' See above Signature of Hauler Date See above Signature of Receive . .ng Facility for attach facility receipt)�.....�.IT I�ato.._._ .._. ...� ...�___._... ..._ . t5form4.doco 1111 2 System bumping Records Page 1 of 1 Commonwealth of Massachusetts TO Wn 0 f NO rth, do Ver City/Town of No. Andover JUL 0 2025 I oo System Pumiping Record Form 4 art U1 DEP has provided this form for use by local Boards of Health. Other forms may be used, ruit gement 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 CIVIR 15.351. A. Facility I nformation Important:When filling out forms 1. System Location: o on the computer, use only the tab ............. .......... key to move your Address cursor-do not -No. Andover MA 01845 use the return City/Ton State Zip Code key. w 2. System Owner: I Qt Name SAME aw Al Address(if dilfferent from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Component: El Cesspooll(s) Septic Tank Tight Tank rease Trap Other(describe): 4. Effluent Tee Filter present? E:1 Yes, O��No If yes, was it cleaned? Ye�� 5. Observed condition of component pumped: All of this estimated ,informati'oiQi:an-�binding, valid on t the time of umping�. Not responsible beyond the date above.- 6. System Pumped By: Name Vehicle Licens Number J&S Development Corp. d/b/a Stewart's Septic Service 7. Location where contents were disposed: Stewart's Receiving Facilit 2,01 So. Mill St., Bradford, MA 01835 See above n ure of 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 Massach usetts ToWn Of IVOrth Andover City/Town of No. Andover System Pumpl"ng Record JUL 8 2025 Form 4 At -4% DE P has provided this form for use by local Boards of Health. Other ft"' 9 t9pe the information must be substantially the same as that provided here. Before using this fprAlftOlUth 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, t) 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 1 tab 2. System Owner: 00 ,11 Name RAW SAME Address(if different from location) City/Torn State Zip Code Telephone Number B., Pumping Record 1. Date of Pumping 2. Quantity Pumped: ....... Date Gallons 3. Component: Cesspool(s) Septic Tank El Tight Tank El Grease Trap Other(describe). - 4,. Effluent Tee Filter piresent? El Yes El No If yes,, was it cleaned? El: Yes F-1 No 5. Observed condition of component pumped: 9 cc All of this estimated information is non-binding, valid on.ly at the time qtp urn ping, blot reppoqsihla be,yand the data above. 6. System Pumped By: J() (N C- Name Vehicle License Number. J&S Development Corp. d/b/a Stewart's Septic Service 7. Location where contents were disposed: 'Stewart's Receivin Facilit -.20 So. Mill St., Bradford, M,A 01835 .......... See above Signature of Hauler Date See above Signature of Receiving Facility(or attach facility receipt) Cute t5form4.doc,# 11112 System Pumping Records Page 1 of 1 fIf �y +i + Commonwealth of Massachusetts WaCity/Town of No. Andover TO Ot NOrth AndOver System Pumping, Record Form 4 JUL C EP has provided this form for use by local Boards of Health. Other for used but the information must be substantiallythe sane as that provided here. Before yi1thi � with our local Card of Health to determine the form they use. The SystemPumping Record m t I d to, the local Beard of Health or other approving authority withlin 14 days from the pumping date in accordance with 31 CMR 15.351. A. Facility of r ti n Important:When falling out forms 1. System Location: on the computer, , use only the tab key to move your address cursor de net No. Andover M 1 45 use the return ....�.�_ _ �... key. City/Town State Zip Code 2. System Owner: 4","11 �u Name r SAME Address(if different from location,) City/Town State Zip Code ... _ .... ........ _.....__. Telephone Number B. Pumping Record' 1. Date of Pumping2. Quantity Pumped: Cate Gallons 3. Component: El Ce spacl s Septic Tank Tight Tangy °° �`rr6 w 1 Ejol"" Other(describe). 1u � i � n � �� ',MIW�°»IIu,IyI`IW I,I v✓+^ ry �. Effluent Tee Filter present" 0 Yea Ej No If yes, was it cleaned?, 0 Yes El N 5�. Observed con ,i°ion of component pumped: All of this estimated information is non-binding valid 01 at the time of pumping. Not respqqsible beyond the date above. 6. .system Pumped' By: ry 01 ,w Name Vehicle license Number J&S Development Corp. dlbi/a Stewart's Septic Service .. Location where contents were disposed:. Stewart's Receivin Facility, 0 So. Mill, St,, Bradford, M 01835 _ om'r°� wW' ° _ _.._.......��...- ry � u°°� ............ ry ou,w Vw f �i u( �rn"`i + b""'t w+ "i° VWV�wmWu°demo Woo See Signature of Hauler Cate See above Signature of Deceiving Facility(or attach facility receipt) Cate t5form4.doc* 11/12 System Pumping Record Page 1 of I Commonwealth olf Massachusetts Town of IVOI,1h Andover Ci'ty/Town . Andlover System Pumping Record JUL 8 2025 Form 4 Health DEP has provided this farm for use by local Boards of Health. Other forms may be a p,Partm information must be substantially the same as that provided here. Before using this form, check wi ur kcal Beard of health to determine the farm they use. The System Pumping Record must be aubm�itted to the local Board of'Health or other approving authority within 14 days from the pumping data in accordance with 310 CIVIR 15.351 A. FacilityInformation Important:When filling out forma 1 N SystemLocation: on the computer, ir use only the tad � � .� key to move your Address cursor-do not No. Andover MA 1845 use the return � .... _ _ ._ _. key.. City/Town .Mate Zip Code 2. System Owner., tabu ell . V, �,. Name retry SAME Address different if from..._.. _........_ �" location _ ..._ _. ... City/Town State Zip Code .._....._..... _ ...__ _... Telepholne Number B. Pumping /f 100 1. Cute of Pumping ��..... �__ 2. Quantity Pum led: 1 Date gallons 3. Component: Cesspool(s) optic Tank E] Tight Tank raase Trap El Other(describe): __._ ....... 4. Effluent Tee Filter resent" es [3,',,'�"No 1t yes, was it cleaned? Ej 'Yes 3"00' o 5. Observed condition of cempcne t pumped: , ��, � � ,� All of thlia estimated um in information is r°` "nzbNndin' ._valid and at the time cf ... of responsible_ ._ ... .._n beyond the data above. 6. Systeumed y: "'0 m Name Vehicle 0i6ense Number &S Development Corp. d/b/a Stewart's Septic Service '. Location where contents were disposed: Stewar' So. ill t., Bradford, M 01835 , m b„ .o See above „UTm n _.. _.. nature of Na .". Date See above Signature of Receiving Facility(or attach facility receipt) Late t5form4.doco 11f12 System Pumping,'Record Page 1 of 1 Commonwealth of Massachusetts, lown of lVorth A do ver 4A City/Town of No.Andov r .4 System Pumping Record' JUL 8 Form 4 2025 Ar S",q% He 11IN DEP has provided this form for use by local Boards of Health. Other forms m a the j information must be substantially the same as that provided here. Before using this fo Prr m, your local Board of Health, to determine the form they use. The System Pumping Record must be sublmi ted 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 key to move your Address cursor-do not use the return key. City/Town State Zip Code 2. System Owner. tab Name MAM Address(if different from location) No.Andover MA City/Town State Zip Code Telephone Number B. Pumping Record -.100 1 w Date of Pumping 2. Quantity Pumped. Gallons 3. Component: ol(Cesspool( Septic Tank El Tight Tank k Grease Trap Other(describe): 4. Effluent,Tee Filter present? E] Yes -T--No, If yes, was it cleaned? Yes NO 5. observed condition of components pumped. > 6. System Rob y: Name Vehicle License,Number Stewart'Is Septic 58 So Kimball, St. Bradford,MA Company 7. Location where contents were disposed: 20 So. ill St.,Bradford,MA Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc,*11/12 System Pumping Recorde Page I of 1 C m e usetts To Wn ()f NOrth 4-- a 17CIOVer City/Town of No. Andover JUL 20 System Pumping Record Form 4 Depccl DEP has provided this form for use by local Boards of Health. Other formic may be useF., Mqat information must be substantiall y the same a s 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 CMR 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 not No. Andover MA use the return 01845 ke y. City/Town State Zip!Code .._. . 2. System Owner.- *Clab We Name SAME Address,(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 00 1. Date of Pumping Date 2. Quantity Pumped: Gallon s 0 3. Component: Cesspool(s) Septic Tank Tight Tank E:1 Grease Trap, Other(describe) ao 4. Effluent Tee Filter present? El Yes M No If yes, was it cleaned? El Yes 0 No 5. Observed condition of component pumpeld': All of this estimated information . non-binding, valid onl at the time of um.. 0 ping. N t respqn ible, beyond the date above. 6. System Pumped' By: Name Vehicle License Number J&S Development Corp. dl/b/a Stewart's Septic Service 7. Location where contents were disposed: Stewart's Receiving Facility, 20 So. Mill St., Bradford, MA 01835 2 9-2�( 1-1 ) :_� 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