HomeMy WebLinkAboutSeptic Pumping Slip - 46 STANTON WAY 6/15/2016 -
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Commonwealth »f &»a,,� arhusetts RECEIVED
City/Town of North Andover ]U| | l 9O1K
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` ~ ~~ - YOWNOFNORTHANOOVER
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HVLHDERARTMENT
DEP has provided this form for use by local 8manjs of Health. [therforma may be used b I the
infunnabon must beaub�an�a|!y the same as that provided here Before using �hiafor` �"eokv�� |
|ooa| BoandcfHea|thtodaterminatheformtheyuse, TheS .�te- Pumping Record m '^� ~^ eubmi
the local Board of Health or other approving auihohtywithin'- -'days�nm the pumpin~°"�^in
accordance with 31OC&iR15.351. pumping date
A. Fac8fityWarmation ��----
Important:` When
mUngmut Toms System
on*ecompma�
�eon|y�e�u �
�y�mmeyour � -'-'--------'-------_-' -- _--___-_-___'
oursm,-uunm /
use'the North Andover �
key. City/Town �----�---- --'--�� Sta���
Zip Code
2,
System Owner: �
j�cl yna
" mama -- ---'-' -- -'------'------ �
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xuun�uVf�x�=n �ommoa�on -------- - -' -- ----'----------
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������`���� �
°~r.v=n . ���______________
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Telephone Number
B. Pumping Record
I. Date of Pumping
'e --Quantity Pumped�
-6 a Zki 2
. ^. Type msystem: LJ Cesspool(s) [:4.1 SepdcTank �l �ightTank E7 GneaseTra �
DOther(describe): ---------`__-,_-___�------------'-------------
4. Effluent eeFUh� present? �� Yea -��~�
` �� L2 mo hyea. was i-(oleaned? Yes 17 No
5� Condition ofSystem: �
6. System Pumped By:
..=°e �����_-__--_-'__��__
Stewart's Septic Service venmeucenoawvmbe �-
Eompany ----- --- '-
/� Location where contents were disposed:
-~wart's .Pre-treatment Plant, 20 So, Mill Bradford, Ma 01835
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=e"amreovHauler �--------- —'-----''-- -__--
Date
��nam�ornaoeivno��cnw� ' - -- - �' --' ------ --- --_-_____--
k5mnm4.umc-03m6
uvy�m Pumping Record'pan* i �