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Home My WebLink AboutAugust 2025 - Septic Pumping Slip - 351 WILLOW STREET 8/29/2025 Commonwealth of Massachusetts TOWn of N- City/Town of No. Andover A"doVer System Pumping Record Form 4 SEP 8 5 1b DEP has provided this form for use by local Boards of Health. C thugrefarms may be used, but the information must be substantially the same as that provided here.9"UjiroLb check with your local Board of Health to determine the form they use. The System Pumping Recopw�'P Chen 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 I n formation Important-When filling out forms 1. System Location: on the computer, use,only the tab ...... -OW key to move your Address cursor-do not No. Andover MA 01845 use the return key. City/Town State, Zip Code 2. System Owner: it CO I I Name Address if different from location) City/Town State Zip Code Telephone Number B. inn corgi hre 2. Quantity Pumped- 1. Date of Pumping Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank <11 1 � �Grease Trap El Other(describe): 4. Effluent Tee Filter present? El Yes D No If yes, was it cleaned? El Yes El No 5. Observed condition of component pumped: .......... 'A All of this estimated information is non-binding', Vial only at the time of m i..n�Not responsible beyond the date above. 6. Sy,st�7, Pumped By: .......... Name Vehicle License Number J&S Development Corp. d/bi/a Stewart's Septic Service 7. Location where contents were disposed: Stewart's Global Environmental, LLC .......... fit,, Bradford, MA 0 1835 See above Signature of Hauler Date See above Signature of Receiving Facility(or attach facility receipt) Date t5form4.doco 11/12 System Pumping Recorde Page 1 of 1 Commonwealth f Massachusetts City/Town No. Andover I i> System Pumping Record Form Ao DEP has provided this form for use by local Beards of Health. Other farms may be used, but the information must be substantially the same as that provided here. Before using this farm, check with your local Board of Health to determine the farm 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 C IVI R 15.351. A. FacilityInformation 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 C 1 ,45 use the return �.....__ m.._._ _.. _...M. _._.. ..... ... . key. City/Town State Zi,p Code wtab o 2. System Owner: T Of NMh Andover I 1,4�e Name ...... .._.._..........� ... r��rr Address(if different from location) City/Town State i Code P Men t .__...._ ...m.......,,.....__.... .. "Telephone Number B., Pumping W d �ry , 1. Cute of Pumping date __.._. 2. Quantity Pumped: Gallons 3. Component.: E] Cesspool(s) Ej Septic.dank Tight Tank Grease Trap 0/00ther(describe): w0/1 4. Effluent Tee Filter present? Yes No It yes, was it cleaned" E:1 Yes El No . 5. Observed con ition of component pumped: 01e; All of this estimated information is non-bipding, valid only at the time of pumpi Not responsible beyqnd the dote above. 6. Syste umpedy� ,00 Vehicle License Number J&S Development Corp. d b/a Stewart's Septic ,service 7. Location where contents were disposed: Stewart's Global Environmental, LLCM MAC 01835 fee above Signature of Haulier Cate See above Signature of ReceivingFacility(Car attach facility receipt) late t5fdrm4.dcc& 11/12 ,System burn ing record•Page I of I Commonwealth of Massachusetts z City/Town of No. Andover 0 System Pumpi"ng Record /J A f sqlb 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 CAR 15.351. AN Facility Information Important:When filling out forms 1. System Loication: on the computer, use only the tab V) 0 1,,) key to,move your Address cursor-do not No. Andover MA 01845 use the return M_._key. City/Town State Zip Code 2. System Owner: Town of 0� IN h Andover J 0 v Name P I:et=:It a MF Address(if different from location) ........... U4 - City/Town State Telephone Number B. Pumping Record 1. Date of Pumping 2,. Quantity Pumped.- __...�� Date Gallons 3. Compon t: El Cesspool(s), Septic Tank [:1 Tight Tank E:1 Grease Trap ;Other l(describle): 4. Effluent Tee Filter present? E:1 Yes\0-.,No If yes, was it cleaned? 0 Yes Ej No 5. Observed condition of component pumped.* All of this,estimated information is n�on-bin,dipg, valid only at the time of mping. Not re§pql!l ble beyond the date above. 6. S Xye Flumpedpy-,— A,�11 . e1,.1,.,,,10 \,,j ........... Name Vehicle License Number AS Development Corp. d/b/a Stewart's Septic Service ........... 7. Location where contents were disposed.- Stewart's Global, Environmental, LLCM 2 ;/Milllst., BradfqqrA.--,MA 018,35 A See above Signature of Hauler Date See above Signature of Receivinig Facility(or attach facility receipt) Date t5form4.doc,, 11/12 System Pumping Recorde Page 1 of 1 Commonwealth of Massachusetts Ci'ty/T'own of No. Andover 0- W�M o 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 wing 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 ClR 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 01845 use the return .......... key. City/Town State Zip Code tab 2. System Owner: I C9 e T 1-4-h-Ando-ver. n c, Name Address(if different from location) S 1,2025 City/Town State Zip Code Telephone NbAsivil" B. Pumping Record 0,(D 1. Date of Pumping 2. Quantity Pumped: q D Date Gallons 3. Component:, Q Cesspool(s) Septic Tank Tight Tank Grease Trap et her(describe): 4. Effluent Tee Filter present? El Yes Na If yes, was it cleaned?, F-1 Yes E] No 5. Observed condition of component,pumped: 0 do�c All of this estimated information is non-b indinc valid ori] at the time of urn in Nqt resp n ible beyond the data above. A P 6. Syst P, pe,--,-,.y: C� .............. Name, Vehicle License Number AS Development Corp. d/b/a Stewart's Septic -Service 7. Location where contents were disposed: Stewart's Global Environmental, LLC _20So.-Mill St., Bradford, MA 01835 See above .................. ------ ature of Hauler Date See above Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc,e 11/12 System Pumping Recordo Page 1 of 1 Commonwealth of Mas 'ity/Town of No., Andover Pumping_ System Record Form 4, F DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must he 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 umlping Record must be submitted to the local Board of Health or other approving authority within 1 days from the pumping date in accordance with 310 CMR 15.351. A, Facility Information Important.When filling out farms 1. System Location: on the computer, use only the tab key to move your Address cursor do not No. Andover, M01845 use the return y y �w _._ _._.. _ ... _.... � key. Cit /Town State Zip Cade t8h 2. System rner Name rem .... Trman-ot,,-No,d-Andover— Address(if different from location) a NeV V City/Town State d SEPP Y2025 ............. Telephone Number _ Bi. Pumping Record -h D e p a-rt m e n t 1* Date of Pum In Quantity Pumped: , °W �, _.�..�_.__��_._._ �... mm._.._ Date Galllons 3. Component: [ Cesspool(s) 0 Septic Tank El Tight Tank Grease Trap Other(describe): . Effluent Tee Filter present's Yes If yes, was it cleaned' Yes, He 5. Observed�qndition of component pumped: 10 All of this estimated valid onl a�t the time of um in . Not res onsi _.. . information ��non-binding,�� .�..��... p� p �. ....�.�..� bl beyond the date above., 6. System Pumped By: Dame Vehicle License Number J B Development Corp. d/b/a Ste rart's Septic Service w Location where contents were disposed: Stewart"s Global Environmental, LLC 20 Bo. Mill Sit., Bradford MA 01835 See a b o v � Signature of Hauler Date See above Signature of Receiving Facility or attach y receipt) late t5form4.docs 11l12 System Pumping Record#Page 1 of I Commonwealth of Massachusetts Town of oril U'City/Town of No. Andover ndoVer System Pumping Record Form 4 SEP 2.2025 N DEP has provided this form for use by local Boards, of Health. Otherjorms, may be used, but the A information must be substantially the same as that provided here. Betbre usin,gN, form, check with your local Board of Health to determine the form they use. The System Pumping� 00like,ftemitted 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, LA./;10 use only the tab key to move your Address cursor-do not No. Andover MA 01845 use the return City/Town State Zip Code key. 2. System Owner: Name tee Address if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 7 115, 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Component". F] Cesspool(9 El Septic Tank Tight Tank Grease Trap ........................ Other(describe): Zil CO 4. Effluent Tee Filter present? [:1 Yes If yes, was it cleaned.? [:1 Yes El No 5. Observed cp,pidition of component pumped: o 0 All of this estimated information is non-binding, valid onlyat the time of purnping. Not responsible beyond the date above. 6. System Pumped By:,-.", 61 ............. Name Vehicle License Number J&S Development Corp., d'/b/a Stew art's Septic Service 7. Location where contents were disposed: Stewart's,Global Environmental, LLC � �S mil f St., Bradford, MA 0 1835 Z See above Signature of � �o H a ule r Date See above ... Signature of Receiving,Facility(or attach facility receipt) Date ........ t5form4.doco 11/12 System Pumping Record Page I of 1 Commonwealth of Massachusetts l ver 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 data in accordance with 310 CM 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 01845 use the return key. City/Town State Zip Code 2. System Owner: tau Name Address(if different from location) 5 City/Town State SEipCodt, Telephone Number r B. Pumplii 1. Date of Pumpling Date 2. Quantity Pumped: Gallons 3. Component: Cesspool(s,) F1 Septic Tank [] Tight Tank El Grease Trap o EI e- /Other(describe): 4. Effluent Tee Filter present? Yes No, if yes, was it cleaned? Yes [] No 5. Observed condition of component pumped: 711S" All of this estimated information is non-binding, valid o �t the time;of pun ing. Not re§ponsible be ond the date above. y 6. System ul ped �. Name Vehicle License Number J&S Development Corp. d/b/a Stewart's Septic Service 7. Location where contents,were disposed: Stewart's Global Environmental, LLC 20 So.-Mlil,l St., Bradford, MA 01835 See above i`oHauler-' Date See above Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc*11112 System Pumping Records Page 1 of 1 Commonwealth of Massachusetts City/Town of No. Andover System Pumpin g Record Form 4 DEP has provided this form for use by local Boards 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 CAR 15.351. A. Facility information Important:When filling out forms 1 System Location: on the computer, use only the tab [4'lf o co key to move your Address cursor-do not No. Andover-_ �IVIA 01845 use the return City/Town key. State Zip Code tab 2. System Owner: Name teun Town, of No�h ndover Address, if different from location) P City/Town State HL I Z Telephone Number helm 0M .7 B. Pumping Recordrt CDC)(,) 1. Date of Pumping Date 2. Quantity Pumped.- --/f— —-______ Gallons, 3. Component: El Cesspool(s) Ej Septic Tank Tight Tank Grease Trap 2"'Other(describe): 4. Effluent Tee, Filter,present? E] Yes Na[2/ If yes, was it cleaned? El Yes E No 5. Observed condition of component pumped: All of this estimated information is non-bindi.ng, vpflld',onl I the time of u et res opsible, be end the p 9 g _N_.p _�__yq_ 6. System Pumped By: Name Ve�hli'cle License Number AS Development Corp. d/b/a Stewart's Septic Service 7. Location where contents were disposed: Stewart's Global Environmental, LLCM 20 So. Mill St. Bradford MA 0 1835 See above i�gg cl�_7-5-111 nature of Hauler Date See above Signature of Receiving Facility or attach facility receipt) Date t5form4.doc*11/12 System Pumping Recorde Page 1 of 1 Commonwealth of Massachusetts City/Town of No. Andover i> m_ 10 System Pumpi'ng Record 0 Form 4, DE P 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 data in accordance with 310 CMR 15.351. A. Facility Information Important:When I filling out forms 1. System Location: on the computer, use only the tab key to move your Address cursor-do not No. Andover MA 01845 use the return Cilty/Town S Zip C ,State Zode ey. 2. System Owner: I b I Ut-9 011 Name Own Ta Address(if different from location) a0var City/Town State *Zip Code SE 2025 Telephone Number B. Pumping Record (r� Went in 1. Date of Pumping 2. Quantity Pumped: ------Lj- Date Gallons 3. Component: El Cesspool(s) 0 Septic Tank El Tight Tank El Grease Trap Other(describe): U ...... 1 4. Effluent Tee Filter present? [:1 Yes, E Na If yes, was it cleaned?, E:1 Yes [] Na 5. Observed condition of'component pumped: /11111 All of this estimated -i niformation is non-binding, valid oq!y�t�te_time o�pu ping, Not responsible beyond the date above. 6. System Pumped By: Name Vehicle License Number J&S Development Corp. d/b/a Stew art's Septic Service 7. Location where contents were disposed: Stewart's Global Environmental, LC A2 So., Mill St., Bradford, MA 0183,5 See above Signature of Hauler Date See above Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc,p 11112 System Pumping Record Page 1 of 1 Commonwealth of Massachusetts y o. Andover TOWn OfNo�h Andover System Pumping Record Form 4 Al SEP 2 2025 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 her efore using this form, check with your rT ' local Board of Health to determine the form they use. The Syste "A ubmitted to g[Dr the local Board of Health, or other approving authority within 14 days from the p r pin!r0al Pit accordance with 310 CIVIR 15.35,1. A. Facility Information Important:WWien filling out forms 1. System Location: on the computer, use only the tab 57,1 t/u 1,1 key to move your Address cursor-do not -No. Andover MA 01845 use the return twit State Zip Code tab 2. System Owner: f .......... Name few Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped Gallons 3. Component: Cesspool(s) El Septic Tank 0 Tight Tank [Z""Grease Trap El Other(describe).- ............. ............ ...... 4. Effluent Tee Filter present? Ej Yes ,","No If yes, was it cleaned? E] Yes--0 No 5. Observed condition of component pumped: All of this estimated informatio ,bi nding v beyond i�FFnor,�- , valid only�tjhe time of pyMpinq._Not re ponsible the date above. 6. System P,umped By; 2 ?................... Name Vehicle License Number J&S Development Corp. d/b/a Stewart's Septic Service 7. Location where contents were disposed: Stewart's Global Environmental, LLC 2cw0 � IVIA 0 1835 .......... ................. See above ig,naure,"D av, Date See above Signature of Receiving,Facility(or attach facility receipt) Date t5form4.doc*11/12 System Pumping Recordo Page 1 of I