HomeMy WebLinkAboutSeptic Pumping Slip - 61 ESSEX STREET 5/17/2016 _ -
RECEIVED
Commonwealth Of Massachusetts
u W City/Town Of
System on Record
Form 4 �� c err
w
HE i
DEP has provided this farm for use by local Boards of Health. ther farms may d, b t the
information must be substantially the same as that provided he . Bef , �.a�sn �t tm, eck with your
local Board of Health to determine the form they use. The Syst m Pumping Record must submitted to
the local Board of Health or other approving authority. OWN �F N O, x �AA,i)���P must
A. Facility Information
1 Left rear of htiioonn: Left side of-bot ;-Right side of house, Left front of house, Right front of house,
.Y__ c� aouse
-
Address
City/Town State Zip Code
2. System Owner: mm "
Name
Address(if different from location)
City/Town State Zip Cod
Tele)phone-Nu6iber
B. Pumping Record
1. Date of Pumping Date 2• Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) 2—peptic Tank ❑ Tight Tank
❑ Other(describe): —
4. Effluent Tee Filter present? ❑ Yes No If es was it cleaned?
y F-1 Yes ❑ No
5. Condition of System:
6. System Pumped By:
_Neil Bateson _
Name Vehicle License Number F5821
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
Lowell Waste Water
S' rn ur of Haul r Date
t5form4.doc>06/03 System Pumping Record•Page 1 of 1
r
sys'rEM PUMPING RE' COR
DATE:
f
SYS TW OWNE R& ADDRESS �.. _ SYSTEM LOCATION
(example: left frout of house)
LA-
DATE
( ( ,�3
CESSPOOL: NO YES EPTIC TA O YES
NATURE, OF SERVICE: ROUTINE, ELI +'I GENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVE R
HEAVY GREG � DAPPLES IN PLACE
ROOTS LLACHF`IELID RUNBACK
EXCE SSIVE SOLIDS FLOODED
SOLIDS CARRYOVER .� _ OT ,R(E PLAIN)
SyS a, ixtr m Yd Bateson Enterprises, Inc
COMMENTS:
CONTE SFE D'T0, .Le a LowellWasto..
TOWN OF NORTH ANDOVER
SYSTEM
DATE:
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
,k
(example: left front of house)
(AC
.. .,
0")
DATE OF PUMPING:
QUANTITY PUMPED C GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO: °
Connm)mealtl9 of Massachusetts
Sy«atenl Owner System Locadon
Al
a
N
Date of t'umping: � � . � Quairtity 1'umped: ���,�,F gallons
Cesspool: No Yes Septic, Tanlc No [] Yes
System Pumped by: Ferredoo (er Ma License #
Contents transrewrred to : treater awrence Sao District _
Date: --- —- ------ ___ 111spector --- -
,ol,111tonwealth orklassachusetts
W*sachusett
, s
e_.
System OwIler System Location _
t '
Date of Pumping: " (6— Quaiatity pumped: � ��� gallons
Cesspool: No _.. Yes Septic Tatik: No Yes
System Pumped by: ctreldce Efi&11104idw License# _
Contents transterrred to : renter ,�wrenc� atL1t C ,lstrtct
.Date: _—- ----- —__—_ __Inspector:
r
1
Town of North Andover, MA
Watershed Septic System
servicing Report
Date:
Homeowner: Pumper
street �' ( 4 Address•
Phone : l� � `� Phone
Nature of Service: Routine
Emergency
Observations: Good Condition
Full to Cover
Baffles in Place
j Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Description of Work:
Comments: