HomeMy WebLinkAboutSeptic Pumping Slip - 135 JOHNNY CAKE STREET 2/9/2016 . -
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Commonwealth of Ma,,� achusetts
CU'tV/ JVR of North Andover
System Pu00p^ng Record '
Form -,
DEP has provided this form for use by local Boards of Health. Other forms may be uaed, but the
information must be substantially the same as that provided here. Before using this form, check with �
/uoa/ Board of Health on determine the form they use. The System Pumping Record must boaubmi-t�e
the local Board of Health or other approving authority Within 14 days from the pumping date in
accordance with 31OCMR15.351. .'
A. Facility Information
Important:When
illingmut forms 1. System Location-,
on the computer, ^
use only the tab /~~� ��,
�ym move�wr Address �����-----�--------------'---------� � --------------
cumor-uvpm
use the return North Andover -__-- -----_' �
xav ^^n/vw» state Zip Code
2 System Owner: 6
0~
wame - --�- ----- -- ----------'----'--------
Address(if different from location)
Citynown �--------------'-'-- � - -State State—'----------------- ------------
Zip Code
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B. Pumping Record
'
1. Date ofPumping 2. Quantity Pumped:
3. Type ofsystem: 0 Cesspool(s) Septic Tank El Tight Tank Fl Grease Trap
LJ Other �
4. Effluent Tee Filter present? Yes m' No If yes, was it cleaned? Yes D No
5. Condition of System:
/ __--_____-
- -'-~-
Name ~' ���-------- --'------'----------
veh�eL�enseNumber
Stewart's e tic Service
C omp ----' --- '-
7. Location where contents were disposed:
atewa/ ur/e _Bradford, NeO1835 _______ _____ _
aigvatuevfVav|e, �--------'-'--- '------''-'' ''------------------
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Signamrecv�ece�nn ccjkv --- - ' - -' ���---- ---' ' -------------
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