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Home My WebLink AboutBake and Joy May 2026 - Septic Pumping Slip - 351 WILLOW STREET 5/1/2026 0 own of NWI"i Andover Commonwealth of Massachusetts, y�/Tlolwn f No. An,d�over JUN 1- 2026' C1 ........... > System Plumpling Record Form 4 Heal'th, urDepartment DEP has provided this form, for use by local Boards,of Health. Other for may be used, but the i information must be substantially,the same as,that provided here. Before, u1sing this form, check with your local Board of Health to determine the for they use. The System Pumping Record must be submitted to the local Boardl of Health or,other approvinng authority within 14 days from the plumpiling date in accordance with 310 CMR, 15-351. A. Facility Informaltion, Important:When filling out forms 1 System Location, on the computer, ........... use only true tab ............. 7 ------- ........... key to move your Address cursor do not No. Andover MA 0 1845 use the return ........ ke�y. Ci,ty/Town State Zip Code 2. System Owner- lob t�v Same -,- 11 1-1-1 1........ _....._........ .......................... ........................................... -------------- ...... Name .......... ..................... .............. ............ ....................... ...... ....... Address(if dii'fferent from location,) ___I_............. ...................... w. ...... ........... ............. .............................. ............ City/Town State Zip Code ........... Telephone Number B. Pumping Record .......... 2. Quan�tity Pumipled- D 61 "G- 3. Componeft- E] Cesispooll(s,) Septic Tank Tight Tank Grease Trap Other (describe),�� Q J11- ................. ............. 4. E,fflu�ent Tee Fil�ter present? Yes, [� No If yes, was, it cleaned? Yes N�,o 51. Observed cond:ition of'compon,erat pumped: All of thlis estimated information is non-bi.nd' val�id only at the time of Urn n,q. Not rej�ponsibile be d ............ y9n the date above. 6. System Pumped By: --1-- 4 ------------------ . .. .. .. .......... ................. Name Vehicle License Number Ji&S Development Corp�. d/'b/a Stiewart's Septic, Service, 58 So,. Kimball St. it, Bradford, MA O 835, -------------------- ........... ........... 7. Location where,contents were disposed- Stew�art's Receiving Facilit 20 So. Mill St.,, Bradford,1 MA 011835 See -above .............. ------ ............. Signature of Hauler Date ............................-................ ------------ .................- S�iignature of Receiving Facility(or attach facility receipt) Date t5form4.doc,o 11/12 Systerni Pumping Record-Page 1 of 1 lb"M of Nc�h Andover L,\ Comm�onw,ealth of M�a,ssachu�sett,s, City/Town of Nol. Andover JUN 1- 2026 System Pumping Record Form 4 Her7nl'h Department D�EP has provided this form for use by 1 lI rds of Health. Other forms may be used, but the information must be substantially,the same as,that provided here. Before in this,form, check with your local Board, of Health to determine the form they use. The Systern Pumpling Record must be submitted to, the, local Board of Health or other approving authority wi,th,in 14 days from t umpli te in accordance with 311O CMR 15.351. A. Facility Information: Important:Whein filling out forms '1, Sy stern Location- ell on the computer,, use onily the to i , ................. ............ ..................... ------------------ key to,move yoar Address, cursor-do,not Nio:. Andover MA 01845 usethe re�turn ....... ....................... .................... key�. City/Tolwn State Z,ip Cod�e 2. System Owner- Same ..........................................-------------------------- ............................ ................................... 00, Name ..................................................... ...... ............... .................. Address at d:i,fferent from locationi) - ....---------- ......................................... .. . ............. ..... .......... ....... .. ..... City�/Town State ZiP Code -- Telephone Number B. Plumping Record 15�_/5�,_O 0 1. Date of Pumping,i Date ...... 2 Quantity Pumped. G�allons, 3. Component- Cesspool(s): Sleptlic Tank Tight Tank Grease Trap Other(describe),-. .............................. ...... ............... . ......................... ......................................... 4. Effluent Tee, Filter present? [I Yes [2 No if yes, was it cleaned? Yes [I No 51. Observed condliti'on of'componerat pumped: All of th�is estimated information is non,-bi,ndin,g.,,.,,va,li_d o,nl,y,,,at the t,ime of_pumpin Not respons,ible bey the date above. ............. ...... 6. System Pumped By: .... C�n ....... ...................... Name Vehicle License Number J&S Development Corp. d/b/a Stewart's Septic Service,, 58 So. Kimlba,ll S,t�., Bradford, MA 011835, ........... 7. Location where contents,were disposed: Stewart's ,Receiving Facility_20: So. Mill St ,, Bradford, MA 01835 j .......... OL 9cr 4 -To YI-e S See above, .................. ................ Signature of Hauler Date ................. ...... ...... Signature of Receiving Facility(or attach facility receipt) Date t5form4,d'oc- 11/12 System Pump�ing Record Page 1 of 1 Commonwealth of Massach�u�s,etts Town Of NOM Andover Cit,y/Town of No.Andover JUN 1 2026 System Plumpin�g Record 0- Form 4 NA, 4 a Depaill M!en.11 t DEP has provided this, form for use by local Boards, of Health. Other forms may be u�sed�,, but the information m�uIst be substantially the same as that provided her 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 alluthorilty within 14, days from the pumping date in accordance with 310, CMR 15.351. A., Facility Information Important:When filling out firms 1 System Location: on the computer, use only the tab key to,move you�r Address cursor-do not use the return ke ..�.._m�__��.m�m__.� _�� .�._..._._.._ ._._ �.�e..w.�_... �� ------- y. City[Town State Zip Code 2. System Owner-. tab Name IE Address if different from loc,ation) No.Andove,r M�A City/Town State Zip Code .......... Telephone Number Bi. Pumping Record 1 Date of Pumping Date 2. Quantity Pumped., dAns 3,. Component: Cess,plool(si), Sep I tic Tan�k 'Tight'Tank Grease Trap Other ribe),-, ...... 4. Effluent Tee Filter present? �..............I Ye NO If yels, was it cleaned? Yes No 51. Observed condition of component pu!mpe . 61. System mpled, E —------------ a Vehicle License Number St�.,� .., -�. �....,.ewart s, Septic 5,8, Sol Kimball St. Bradf'olrdl,MA Company 7. Location where conit nt,s were disposed, 20 SoiMA-5f;�W dfordW----`-'-'-7. ............. ------------- ------- ........... Signature of Hauler Date ........... -------- Signature of Receiving Facility or attach facility receipt) Date t5fbrm4,.doc*11/111 2 Systern,Pump�ing Record-Page 1 of 1 �._� �_� i 1 VIV"tj Andovcr Com�mo!nweal'th of Massachusetts City/Town of No. Andover -'7 JU�N 1, - 2026 m:pin Sy�stem Pu g Record AN Form 4 Dep irfm DE,P has provided this form for use by local Boardls,of Healtth., Other forms may be used) bu,,ttllh�",,,,ent information must be substantial,ly the same as,that provided he�rel, Before using this form,, check with your call Board of Health to defer ire the form they use,. The System Pumpling Record must be submgi,tted to the local' Board of Health or other appr,ovi�ng authority within 14 days from the pumping date i�n accordance with 310 CMR 1 51-351�. A. Facility Information Important:When filling out forms 1. System Location: on the compu�ter, use on�ly the tab, ............... ................. key to move,your Address cursor..do not No. Andover MA 011845 use the return ......... ------------ ...... .................. ............ -------- key., City/Town State Zip,Code 2. System Owner- lab Jot', Same .............. Name ............... ......................... Address if d,ifferent from location,) .................... -------—----------------------------- .............. .-................. .............. Qtyffown State Zip Code -11--............. ........... ...................... Tel hone Nurns r B. Pumping Record 1 Date of Pumpling, Da t e 1 2. Quantity Pumped: -G--"ilo�n s I Component- Ce�s,spool(s) Septic,Tank 1 Tight Tank El Grease Trap, El ....................................... ............................-............... ........... ...... i l Other(describe)-, 4. Effluent Tee Fillter prare ? 01 Yes No, If yes,, was it cleaned? Yes, 5. Observed condition of component pum d' A All of'th�is estimated valid oril at the time of 9. Not responsible b d the date above. information is non-bindi ........... st 6. Syst Pu ed B ................... ..................... .................... r4� Na le Vehicle License Number AS Development Corp. d/b/a Stewart s Septic Service, 58 So. Kimball St., Bradford, MA 01835 .................................... ............ ......... ........... 7. Location where,con rats yefe '81 MA 01835 Stew4 j"0 : I ...............--...... --—------- ........... ................ 00,00, 01/ 000000"0010 See, above ............... .................... ........... ........................... ......... Signature :aul�kr Date -—---.....---.......... --------------- .............. ............. Signature of Receiving Facility(or attach facil'ity receipt), Date t5form4,d1oc- 11/12 System Pumping Recorde Page 1 of 1 Commonwealth of Mass,ach!us,ett,s Of N!Mh Andover City/Town of No., An,dov�er - 2026 JUN 1, .......... System, Pumping Rec,ordi .. .......... As Form, 4 Deplartmenit D�EP has, pirolvi,deld thi's form for use by local Boards of Health. Other forms may be used, bust the in:format,ioln must be substantially the same as that prolvideld here. Blefolr,e using this form, check with your local Board of Health to determine the form they use., The System Pumping Relcord must be submitted to the local Board, of Health or other approving authority within 14 days from the plump,ing date in accordance w�ith 310 CM:R 15.3151. A. Facility Information, Important:When filling out forms 1 System Location-. on the computer, u1se only the tab ...................... . .............................. key to move your Address cursor-do not, No. Andover MA 0 1 84�5 use the return ....... kely, City/Town State Zip Code, 2. Slylstelm Owner: lab11 .2 Same ................................ ........ ---------- ................ ............... ........................ ........ ........................................ ....................------ Name ---------- -.1........................................ ------- .................... ........... Address(if different,from location) City/Town State Zip Code ................. ....... Telephone Number B. Pumpling Record -;4, ?v" 1. Date of Pumping 2. Quantity Pumped'. ........ Date Gallons 3. Colmponent.' Clels,s,polo,I(s) S,epit,ic Tank Tight Tank Grease Trap 6ther(describe): 4. Efflueln t Tee Filter present? E] Yes [� If Yes,, was it cleane�d? E Yes E N ol 1 5. Observed cond'itilon of component pumpled"', All of this estimated, information is non-binding.,_,valid only.at the time of pumpin Not responsible blel o�nd the date above. ..............------------ ----........... --------- Y- .............I.............. 6. System Pumped By�: ................. -------- .......... ............... ...... Narne Ve,hic,le License Nu,m,ber AS Development Corp. d/b/a Stewart's Septic Service, 58 So., Kimbal�l St.,, Bradford, MA 01835 7. Location where conten�ts were disposed-, Stewart's, Rec -ei�vin Facilit 20 So. Mil,l St., Bradford, M,A 01835 ------------ .......- ------------ Ile See, above, signature of Hauler Date -1-.-............ ...... Signature of Receiving Facility or attach facility relceupt), Date t5form4.doc,,11/12, Syst, m Pumping Record Page'l of 1 ��vniindover Commonwealth of' Massachuset,ts City/Town of Nov Andov�er JUN I- 2026, System Pumping Record: LW Foir�m 4 U 4 Department DEP has provided this form for use by local Boards of Health. Other,forms may, be used, but the information rest be substantially the same as that p�rolvided, 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 with�in 14 days from the pumpling date in accordance with 310 CMR 15.351. A. F acility Informati on Important-,Whe'n fil�lin out forms 1 System Location, on the computer, use only the tab --------- key to move your Address cursor-do not No. Andover MA 0 1845, usethe return .............. ................. ............................................ key. it State Zip Code 2. System Owner'. tab, Same ................ ....... ...... ............ Name rat ................ ............ ................................... ........................... ......................... Address if dii,fferent from location) ......................... City/ "or State Zip Code ............--------- ............................... ...... Telephone Number B. Pumping Record rz� 1 2. Quantity Pumped, ............ ........ ............ ....... Date of Pumping Date Giallons, 3. Component:' El Cesspool(s) Septic Tank Tight Tank E] Grease Trap 40111, c Other(describe): --. Effluent Tee Filter pres,e rat? Yes If y , was it cleaned? Yes, No 5. Observed c r-dition of component pumped* All of th,is, estimated information, is, noin-bindin g,,,,_valid,on)y at the time,oif q.. N,ot,,,respoinsible beyond' the date above,, _,p,um i!n 6�. Systemi Plumped By-, .................-- ......... Name Vehicle License N:umbeir AS Development Corp. d/b/a Stewart'i si Septic Service, 581 Sol. Kimball Sit., B,radfordl�,l MA 01835 .............. 7. Location where contents were disposed- Stewart's ReceivingFacilit � 20 So. Mill St., Bradford,, MA 01835 ....................................... ............... ...... 6, 7 See above ................ Sign�ature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5 for rn4.doc# 11112 System Pumping Record Page I of 1 i own cot Norifl Andover Co,mm,o�nIwealth, of Massachusetts, JUN' 1, 2026i z &in i W City/Town of No,. A,nd.over > ;_ _._ System Pumiplon,g Record Form 4 DePailmenti DEP has prov,ided this,form for use by local Boards of Heal'ith. 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; titer in the form they use., The System Pumping Record must be submitted to the, local Board of Healthy or other approving authority with]n 14 days from the pumping date in accordance with 310 CMR 15.351. A.1 Facility InfoIrmation Important:When filling out forms 1. System Location: on the computer, Use only the tab _awAzi il mm_ ................. key to move your Address, cursor-do,not No., Andover M!A 01845 use the return . y/ Z,ip key Cit Town State Code 2. System Owner- i 18b I Same ..................... ......... ...... ..................... Name raw ............ ............................. .................. ........ Address(if different from location), City/T'own State Zip,Code Teleph,one Number B., Pumping Recoird "_2 1. Date of Pumping 2. Quantity Pumped�- Date Gallons 3. Component: Cesspool(s) El Septic Tank 0 Tight Tank [:1 Grease T'rap 0100 C 4jo,ebther(describe,): '1110 4. Effluent Tee Filter presein�t? [:1 Yes Ej`�No Ifyies, was it cleaned? El Yes [I No 5. Observed c dition! of component plumped- All of this estimated information is noin-bindii,n,,,valid onily_at the time oifpp_Tp the s I b d d�ate _ipg. Noit re ponsib en d e� _ 6. System Pumped Name Vehicle License Number J&Si Development Corp:. d/b/a Stewart's Septic Service, 58, Sol. Kimball St., Bradford, MA 01835, 7. Location where contents were disposed: Stewart's Rece.iving Facility _2�_So. Mill St., Bradford, MA 011835 ?- See above ................................................................ Signature of Hauler Date -----------....... Signature of Receiving Facility(oir attach facility receipt) Date t5form4,doicei 111/12 System Pumping Record Page 1 of 1 of Nofth Andover Commonwealth of Massachusetts C1� /Townly of No.And:olveir JUN' 1 - 2026 ------------ t! System Pumpin�g Record Department Form 4 a DE,P has prolvided this form for use by local Boards of H!ealt,h�. Olther forms may be used,, but the information must be subs,tan�tial�ly 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 Purnpingi 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 CMR 15.351. A., Fac ility Information Important:When filling out,forms 1. System Location', on Nyet computer, use olnly the tab ........... w. key to miolve you r A"ddres,_,s_,_,_`__ cursor-do not use the n key retur . City/Town State Zip Code Z System Owner: op, ................ -Tz Addr6ii70 dli-ff--e"-r,—enit—fr--o-"m—,"I-o,-,c",-a No.Andolver MA C ................ity/Town State Zip Code Tel�ephonie Nuniber ............. B. Pumpling Re c o r`d 1. Date of Pumpling — ------ 2,. Quantity Pumped, 5 a—t e Gallons 3. Component.-, Cesspool(s) Septic Tank Tight Tank Grease Trap 00 C, :7 (describe). 4. Effluent Tee Filter present? Yes "N"O",lo If yes, was it cleaned? Yes N o 5. Observed co horn of component pumpeld- 61. System Plumped By: ........... Name Vehicle License N!iumbler Stewart's S,ep_tI 58 Sol Kimball St. B,r,adford,MA Company 7. Location where c,onlitent,s were disposed: 20 So. ill st.,Bradford,MA ................... 0; > Slignature of Hauler Date Cigna re of Receiving Facility(or attach facility receipt) Date t5form4.doc-11/111 2 System Pumping Record Page 1 of 1 �nrri lof Klot:i Andover ,: o ah of Massachusettmm z City/Town of NoAndover - 2026 JUN I ........... System Plumping Record Form 4 A� h Deplartment DEPI has provided this fir for use by local Boa,f*,ds of Healthi. Other forms may be used, but the in�foirm�atioln must be, substantially the same as that provided here. Before using this form, check with yolu�r I local Bolard of Health to,determine the f'olrm they use. The System Pumping Recoird must be submitted: to V" l : I i I date in the local Board of Health or other approving authority within 14 days f oml the pumpling, accordance wit'h 310 CWR 15.351 A. Facility Infoirmation Important:When filling out forms 1 System L,ocation- oni the computer, 117 use only the tab key to move your Address cursor-do not use the return key. City/Tolwn State Zip,Code 2. cyst ern Owner, tab I? .a.-d,--r e--s-s--T f-'-'d-,i ff--e r-ent No.Andover MA Uy- State Zip Colde Telephone Number Plumplin�g Record 1. to of Pumping Date 2,. Quantity Plumped., Gallons [-I i [...........7 3. Component.-, I tic Ta�nk_j Cesspool(s Tight Tank I Sep P<Grease Trap Other(describe)- 4. Effluent Tee Filter pirels, t? Yes No If ye�s, was, it cleaned? Yes ------- ox "] N o 51. Observed corrdlition of corn onent pumped, System Plumple ,y- Name Vehicle License Number Stewart's Se tic 58 So Kimball St. I Bradford,11VIA Company 7. Location where contents were disposed: 20 So.: t.,Br or A ell 2 ............ ........ :nat re of H: uler Date .......... ......... grnature of Receiving Facility(oir attach facility receipt) Date t5form4-doc- 11/12 System Pumping Recordo Page 1 of 1 Commonwealth of Massachusetts City/Town: of No. Andover PIT 20:26 0 JUN I System Pumping Record, Form 4, i'D ep rt, hnent,7 f e DEP has provided this form for use by local Boards of Health. Other forms ma'y be use Ut information must be subs,tantially the same as that provided here. Before using this form, check it your local Board of Health to determine the for they use. The System Pumpin: Record must be submitted to the local Board of Health or other approving authority within 14 days,from the pu ing; date in accordance with 310 CMR 15-351 A. Facility Information lmportant:When filling out forms 1. System Location'. on the colm!,ptiter, use only the tab, .............. key to m ove your Address cursor-do not No. Andover MA 01 84 5 use the return, key. City/Town State Zip Code tab 2. System Owner- Jol Same Name .......... ................ ............................................ ............... ...............................------- Address,(if different from,location) City/Town State Zip Code ............... -------_-- Tel 'N one Number R. Pumping Record C 0 J0 0 1. Date of Pumping Date 2. Quantity Pumped.- Gallons ........ ...... 3. Complonent,� of Septic Tank Tigh,t Tank El Grease Trap Other(describe): 4. Effluent Tee Filter present? 0 Yes ;:, No If ye s, was it cleaned? Ell Yes El Ni 0 5. Observed condition of component pumped: All of this estimated information is non-binding) valid on[�Wthe time of,pump' Not responsible_4qy nd, the,date above. ....... qjg_ -------- 6. System Pur .......... ....... Name Vehicle,License Number J&S Development Corp. dicta Stewart'i s, Septic Service, 518 So. Kimball St., Bradford, MA 01835 7. Location where contents,were d:isposed'. Stewart"s, Rece' i Facility, 2.0 So. Mill St.,, Bradford, MA 01835 ......................... 41,. ..........7...-7-1 See,above ........ ........... --------- r eider Date Signature of Receiving Facility(or attach facility receipt) Date t5fbrm4.doc* 111 1/12 System Pumping Record•Page 1 of 1 mdover Commonwealth of Massachusetts Cilty/Town of No. Andolver System Pumping Record JUN 1, 2d'26 Form 4 Gtw&nt DEP, has provided this form for use by local Boards of Health, Other forms mg� e4?e9,8b information must be substantially the same as that prov,ided here,. Before us,ing, this form, check with your local Board of lie althi to determ,ine 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 p,umpi,ng date in accordance with 310 CMR 15.351. 9! Al. Facility Information Important,:When filling out forms 1 SystemI Location,: ors the compgar, ........ key to move your Address cursor-do not No. Andover MA 01845 use the return ............ key. City/Town State Zip Code 2. System Olwner- tab Same Name Own .................. ------- .................... ........................ Addiress(if different from location) ........... City/Town State Zip Code Telephone Number. B. Pl umping Record 1 impd:., Date of Pumping Date ally Quantity Pul el Gall"ns 3,. Component: Ciesspool(s) Septic Tank Ti lit Grease Trap 01 Other(describe)- .........___..__._'_.'._............. --------------- 4. Effluent Tee Fi,lter present? [:1 Yes No If yes, was, it,cleaned? Yes [:] No 5. Observed condition of'component plumped: All of this estimated s e 1�e on,d the date above., information is non-bi�dingvalib onfy_at the time_of_p.ymP19R Not r,e pol-nsibl' 61. System Pumped By: .......... .................. Name Vehicle License Numbe�r J&S Development Corp., d/b/a Stewart 11 s, Septic S I ervice, 58 So. Kimball St,., Bradford, MA 0 1835 ,.............. T, Location where contents,were disposed* Stewaq,' o iing v R So. Mill S,t., Bradford, MA 01835 Old See above U 15e Date nature of Receiving Facility or attach facility receipt) Date t5form4.dcc. 11/12, System Pumping Record Page 1 of 1 0,t rm Andover Commonwealth of Massachiusetts, Tovo.in of NO Cliff /Town No. Andover 2026 System Pum ",n Record JUN Form 4 Vent D,EP has rovided this form for use by loca,l Boards of Health. Other folrmB4�-ay�t lziuq, @,poi�t information must be substantially the same as,that provided here. Before us,iing this formi, check with your local; and of Health to determine,the form they use. The System Pumping Record miu:st be submitted to the local Board of Health or other approving authority within 14 days from the purnping date in accordance with 310 CAR 15.351, A. Facility Information Important:When filling out foirm�s 1. System Location:, on the com,pute�r, �0 ulsie only the tab .......... ....... ......... key to m Address cursor-do,not Nio.use the ner M 11 return A 08,45 key. City/Town State Zip Colde 2. System Owner: w l 41 Name retwn I las ............. ...... ---------- ...................... Address(if different from location) ......................................................... .......... ..............................----------- ---------------- ........-------------------------- City/Town, State Zip,Code .......... Telephone Number B. Pumping Rec,oird�, 2. Quiantity Plumped:1 .......Date of Pumping Da,te I I Glall4ns 3. Component- Cessplooll(s) Septic'Tank Tight Tank Grease Trap Other (describe)- -------- 4. Effluent,Tee Filter present? Yes [KI No if yes,, was it cleaned? 0 Yes, El No 5. Observed condition oficomponeint plumped, 9 ca,�' All of theis, estimated information is noni-blindin vali_d,only at the,timel'.'ofp,um Not responisible b ond the date above. pina -----------------......------------------- ........................... 6. System Pulimpled By* Z III OLS,-1 I____....................... ............................. Name Vehicle License Nulimbler AS, Development Corp. d/bi/a Stewart'i s, Septic Service, 518, Sol. Kimball St., Bradford, MA 018!35 7. Location where contents were disposed: St rt's Receiving Faci,l,it , 2,0 So., all Sit., Bradford, MA,018,35 ................. .......... 'e'll a'5" See a,blove ..................... ----------.................................. Signature of Hauler Date ................. ........................I................. Signature olf Recei�vin:g Facillity(or attach facility receiipit), Date t5form4.doc#11/12 System Pumping Record Page 1 of 1 Town of Nofth Ando�ver Commonwealth of Massachusetts 2026 JUN I City/Town of NoAndover ji System Piumping Recore Form ent A/ DEP has provided this, form for use by local Boards, of Health. Other forms, may be used, bu t the i information must be substantia,lly the same as trust provided here. Before using this form, check with your local Board of Health to d i'elte�rmine the forrin they use. The System Pumping Record must be submitted to i thous Heal e local Board of th or other approving authority w,ithin 14 days from the, pu miping date in accordance with: 3110 CMR 15351. A.1 Facility Information Important:When fi�llling out forms 1 System Location'. on the computer, use,only the tab key to,move your cursor-do not ease the return key. Ci�ty/Town State Zip Code 2. System Owner- tab Z ..................... ....... A Name Ron Address,(if different from location) No.Andover MA fiif6 w n State Zip Code Telephone Number Bi. Pumplin g Record 1. Date of Purnping bat 2. Quantity Pumpied. Gallo-ns " ] Cesspool(s) S , nk Ti gh t Tan Gr s Tr k eae' ,ap 31. Com�ponen�t- Sep tic Tyr e, Other(describ ................. 4. Effluent Tee Filter, pres,ent? Yeis, No Ifyes, was, i�t cleaned? Yes 01 N 5. Observed con,d�ition of component pumped- cy ----- 6. System Pum�ped By- Name Vehi�cle License N miter Stewart's S,e i�c 518 Sol_Kim� ..alll Sit. , Bradt �rd,MA Company 7. Location where contents were disposed" 2,01 oMill St.,BradfordMA Signature of Hauler Date Signature of Receiving Facility('or attach fac,ility receipt) Date t5form4.doc*11/121 System Pumping Record Page 1 of 1 ,�L- Town of Nod,Andover Com,mon�we�alth of Massachusetts r-*-_-,-----------------11 City/Town, of No. Andover &A AI JUN 1 2026 System Pumping Record Foirm 4 A,0 H,81th Dc),pip g DEP has provided: this form for use by local Boards of Health. Other forms, may be usea, Out TAIP I I I information must be substantially the, same as,that provided he�re. Before using this form,, check with your local Board of Health to determine the forrn they use., The System Pumping Record must be submitted to, the local Boar r other approvi�ng authority within 14 days,from the pumping date in ,accordance wit . A. Faci lity I nformation Important:When filling out forms 1. System Location- on'the computer, -2, use only the tab, .......... key to move �r Address cursor-do not No. Andover MA 0 1845, use the return ............ ------------------------ ---------- ------- key'. City/Town State Z,ip Code 2. System Owner: tab 0- Same ........................................... ------ ........... .......... .......... ------ Name raw Address(if different from location) ..................... City/Town State Zip Code Telephone Number B,., Pumping Record 1. Date of Purnpiling Date, 2. Quantity Pumped. Gallons 3. Component: E] Cesspololl(s) E] Septic Tank 0 Tight Tank 0 G,reas,e Tra,p -------------------------------- 2//Other(d�escribe)., 4. Effluent Tee Filter present? Yes, No, If y�esi, was, it cleaned? 0 Yes E] No 51. Observed condition of comp nent pumped: All of'this estimated information is non-bip,din valid: on�!y e of, mp* Not responsible beyond the date above,,___atthe tim _,pu __T_g ----------.............. ...... - — ------------------------ ......---------- 6. System Pumped By-, L0001 N rr Vehicle License Number AS Development Corp. d/b/a Stewart's, Septic Service, 58 So. Kimball St.1 BradfordI MA 01835 ........................................... ................ 7. Location where contents were disposed, Stewal Receiving.__Facility,__--O So. Mill St., Bradford, MA 018�35---------- ........................ ................. .............. See above ........................... -------------- el Signatur of Hauer Date ........................ ........ Signature,old'R,eceiving Facility or attach facility receipt) Date t5 for m4,d ocal 11 1:2 System Pumping Record Pagle 1 olf'l Commonwealth of Massachusetts, Tow�n lo-Morth Andolver City/Town of No. Andover 2026 System Pumping, Record JUN I Form 4 DE,P has provided this form,for use by local Boards of Health. Olthelr f44t@fvOftlCe a n iron ormation must be substantially the same as,that provided her Before using this fol m, check wit your local Board! of Health to determ,ins the,form they use. The System Plumping Record must ble submitted to the to Board! of Health or other approving authority within 14 days from the purnping, date in accord It 310, CMR 15. 1. A, Facility Information Important-.Whien filling out forms 1 Systern Locatio�n.- on the computer, u nlythe to ....................----------- key to move your Add,ress cursor-do not No. Andover MA 011845 use the return .............. ............... key�. City/Town State Zip Code 2. System Owner: tab Sa me .................................................... ........................ ...... ................ Name MUM Address(if different from,location) mm ................ ....... ....... ....... City/Town State Zip Code ----—------------ ...... ................ -------............... ...... Telephone Number ......... B. Pumping Record 1. Date of Pumping ......... ----------- 2. Quantity Pumped: ......--------- Date Gallons 3. Component: Cesspool(s) El Septic Tank 0 'Tight Tank 0 Grease Trap ........................ ....... ,............. .................. ........ Other(desicribe!)I� 46 ---I .......... 4. Effluent Tee Filter present? El Yes 90"'No lf'yes l was it cleaned? Yes No 11 5. Observed ridition of component pumpled* C,' ill of this estimated information is n:on-b,indina, val'id on at the time of' Not r in pon�sible bi nd the date above. e ............ 6. Systern Pumpleld IJ .............. Name Vehicle License Number J&S Development Corp. d/'b/a Stewart's Septic Service, 58 So. Kimball St., Bradford, MA 018135 7. Location where cr nt,e�nts w�ere dispose . Stewart'l s, Receiving Facilit , 20 Sol. Mill St., Brad,foir�d MA 011l835 .......... �7 ... 3 See above cq� -91 ................. ............ ...... Signature of Hauler Date ............... ........... Slignatlu�ure of Receiving Facility,(or attach facility receipt) at t5foirm4,doc- 11/12, System Pumping Record-Page I of 1 To vv I c,"0,A 11 11 Commonwealth of Massach�u set ts, 1�"`Orth Ando City/Tolwn of No.An�d�over JUN 1 826 System Pumping Record Form 4 IDEP has provided this form for use by local Boards of Health. Other forms information must be substan�tially the same as that prol ide�d here. Before using this form, chi�v 9-th your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the, l call Board of Health or other approving authority within 14, days from the pumping date in acc rda�nce with 310 CMR 15.3151. A. Facility Information Important:When filling out forms 1. System Location- on the computer, use only the tab key to move,you�r ��66r-e-s's -------- cursor-do not use the return ............ key,, City/Town State Zip Code V 2. System Owner- Name Address(ilf different from location) No.Andov r MA C,ity,/Town State Zip Code ........... Telephone NUrnber B. PU i lin Record 2., Quantity Pumpled.: 1. Date of Pumping D-a Gallons 3 Tight Tank Grease Trap Celssplooll(s) S ep'tic Tank. Component�- ell te [4� Other(describeY 4. Effluent Tee, F'ilte�r pires,ent? Yes [44-'N�o If yes,, was it cleaned'? Yes No 5. Observed c -dition of component pumped- 6. System Plumped By- Name Vehicle License Number St ewa rt's Se,pp.c 5,8, So Ki1mball St radford,MA 7'. Location whiere contents were disposed: 20 SoMill St.,B raw dfor d,MA .......... ......... eel Sigrmature of Hauler Date Signature of'Receiving Facility(or attach facility receipt) Date t5form4.doc-11/12 System Pumpling Record Page 1 of 1 A n do ver Commonwealth, of Massachusetts, City/Town of Nol. Andover Sysitem Pumping, Record, JUN 1 2026, fz` Form 4 H D,E,P has provided this form for use by local Boards of Health. O�th eier forms bi&Wo" C information must be sup bstantially the same as,that provided he�re�. Before using this fo yourrm, chec- 0 local Board of Health to determine the,form they uise. The System Pumping Record m!u t be submitted to the local Board of Health or other apipr inn g authority within 14 days from the pumping d I ate i n accordance,with 310 CMR 151.351 A. Faciflity Information Important:When filling out forms 1. Syste�m, Location: on the computer, key to move your Address, cursor-do not No. Andover MIA 01845 usethe re�tuirn ...... ................................. -------------......................... key. City/Town State Zip Code tab 2. System Owner- A/ Same Name Addr�ess(if different from location) .......... .................. ............................................................... ------ C,ity/ row n State Zip Code ............. Telephone Number B., Plumping Record ez, 1. Date of Pumping 2. Quantity Pumped. Date Gallons 3. Complo ent- Cesspiololl(s) Septic Tank Tight Tank Grease Trap, C"VI z, 1,0 7x ir- E Y/Other(descri�be),. 4. Effluent Tee Filter present? Yes-D--,7No I i, was, it cleaned? Yes, No 5. Observed Ondition, of complo,n nt pumped: All of this estimated infbrmia�tio,n is non�-bind�igg., valid.,only at the time ofpu Not responsible beyond the date above. 6. System Pumped B > ................................................. --- —-------------- .............. ............. Name Vehicle License Number AS Development Corp. d/b/'a Stewart's Septic Service, 58 So. Kimball St., Bradford, MA 018315 T Location where c tents,were, diisposed, Stewart's Re ei "n Fa,cilit , 210 So l. Mill St., Biradf'ord ., MA 01835 ........................... _y 7 al, See above .................................................................. ----- --------------- ....................................... Signature of Hauler Date ............................................... Signature of Receiving Facility(or attach faci,lity r,eceilpt,) Date t5form4.doc* 11/12 System Pu�mping Record Page 1 of 1 ell%"f Towri ij, 4��- -\w Commonwealth of Mass,ach:us,eitts, Andover City/Town of Nlo.1 Andover 4A W System, Pumping Record JUN 1- 20,26 Form 4 DEP, has, provided this form for use by local Boards of'Health., Other fo49 1 information must supbstan Its ally the, same as,that provided here. Before using this form, check wit your local BoardI f Health to, determine,the form they use, The System Purniping Record must be submitted' to the local Board of Health or other approving authority within '14, days from the pumplinsg date in accordance with 3,10 CMR 151.351. A,. Facility Information Importanto When fill1ing out forms, System Location: on the computer, use only the tab ---------- key to,move your Address cursor-do not No., AndIo,v�er MA 0118,45 usethe return ........................ ........ ...... ................. ................... ------- key. City/Town State Zip Code 2. System Owner, SameV`............................................. ........................ ...... ----------- Name .............................. ............................ ............................ Address(if different from,location) ........... ... ....... ................. ............................ City/Tolw�n State Zip,Code ............................................................................................. Telephone Number B,, P lion Record mm --------- 1. Date of Purnping Date ................. 2. Quantity Ga1,r6ns, 31. Component: Cesspool(s) Septic Tank El Tight Tank 0 Grease Trap [50 Other,(describe),*,, -_9 ------------- ............... ........................................................... 4. Effluent Tee Filter present? E] Yes R No, Ifyes, was it cleaned? Yes No 5. ObservedI condition of component pumped: All ohis,esmaed inomaio n is f t ti t f r t -b irow. lid ol. n.y at the time of s o,nd the date above, 6. System Pum : a .............. ------------- .......................................... Name Vehicle Liicen�se N,umber J&S Development Corp. d/b/al Stewart's, Septic Service, 58 So. Kimball: St., Bradford, MA 01835 ---------- .............. '7. Location,where contents were disposed. Stewart's Re e"v' F'acil,it , 20 So., M,il t. Bradford, MA,Oil 835 y- me Is See above Signature of Hauler Date ............................. ........------- ....................... ........... .................................. Signature of Receiving Facility(or attach facility receipt), Date t5for,m!4,.doce '111/112 System!Pumping Records,Page 1 of 1 9 Colmmlo�nwealth of Massachusetts Tol" ()f MOrth AndOlVer City/Town of No. Andover 21026 System Pumping, Record UN I Form 4 Af D,EP has provided this for for,use by local Boards of Health. Other forms, may be us�p, Rafto() t information must be subls,ta,ntially the same as that provided here. Before us,in�g this,form, check it your local Board of Health to, titer ire the form they use. The System Pumpling, Record must be submitted to the local Board of Health or other approving authority within 14 days from the plumping date in accordance with 3110 CMIR 15l.351. "lty Information Facill Important:When filling out forms, 1. System Location.�� on the computer, (Ovo use only the tab key to m ove your Address cursor-do not key. Ny./Andn ove ae 11 u1se the return Citow mitt ____ Zip 8C4o5d, e . ..... 2. System Own Same Lie -------....... ------- ................................................. ................---.............................. Name raw ............ ...................................................................... ------------------ Address if different from location) City/Town State Zip Code ............. Telephone Number B., Pumping Recoird z 11. Date o,f'Pumping 2. Quantity Pu�mpled�: Date Gallon's, 3. Component" Cesspoo,l(s) E] Septic Tank T'ight and E] Grease Trap Other(describe)-. ....... .......... ........... ........... �4. Effluent Tee Filter present? 0 Yes E;d N o, If yesT was it clelaned? 0 Yes El No 5. Observed condition of'component plu�mped* All of this, estimated information is, no�n-bindigg, yplid_,on.1y,at the tirne,of.pum i!ng. Not.res n§,Libl be, nd the date above., ........................... 6. System Pumped By,: APAI ez Name Vehicle License Number J&S Development Corp. d/b/a Stewart's Septic Service,, 58 So., Kimball St.,l Bradford, MA 01835 7. Location where contents,were diisposed- Stewart's tic iv'in acility, 20 So. Mill St., Birad,foird,, MA 01835 we/tool a �0� See above ................ Signature of Hauler Date Slignature of'Receiving Facility(or attach facility raceip't) Date t5form4.doc�- 11/12 Systern Pumpling Record•Page 1 of 1