HomeMy WebLinkAboutSeptic Pumping Slip - 44 OAKES DRIVE 6/29/2016 Commonwealth of Ma,,�sachusefts
RECEIVED
Ci Y/I own of North Andover
SYstem Pumping Record
li-orm 4
WN 0F o�sORTH MIC(11
DEP has provided this form for use by local Boards of Health. Otheii JoFnns'may be 'used, but'Lh(
information must be substantially the same as '-h2- provided here, Before using this form, check
local Board of Health to determine the form they use. The System Pumping Record must be su
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facifity Wormation
Imponan't'When
filling out fours 1. System Location:
on the compeer,
'
use only the tab tA`,) oca,
key to move your
cursor-do not Address
use the return North Andover
key. City/Town
State Zip Code
2.
System Owner:
Address Cif different from location)
State
ZfpCode
' Telephone Number
Pumping Record
—'_U
_L V"
1. Date 0, Pumping j(,Cx--,
Date 2, Quantity Pumped:
o's
3. Type of system: ❑ Cesspool(s) allons
2��Septdc Tank ❑ Tight Tank ❑ Grease '
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes IT Yes, was itcl'eaned? L-1 Yes ❑ No
5. Condition of System.-
6. System Pumped By,
Name ------
Stewart's Septic Service e T icen Number —
Company ........
7. Location where contents were disposed:
Stewart's Pre-'
LreaLm2 t'Plant, 20 So. Mill Bradford, Ma 01835
zure of' auler
Date .......
Signature TReceiving f i acch`it D-ate
,510rr-14.doc-03106
System Pumoino Recnrn-P�r