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SYSTEM PUMPIN )
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DATE PU Nq; �QOA NT1TY P i
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NA rVRU ()F SERVICE: .., ......6MEFiC.1Es1`dC'1'
00I" DInoN FULL TO COVER JUN 3 200
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OXCUSONS SOLIDS FLOODED
RMeLD RUNBACK
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
26
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[).,1,rE0F PUMPING: QUANTITY PUMPED/ err) GALLONS
(. 1-:�.S110OL: NO YES SEPTIC TANK: NO YES
'ti,ATURE OF SERVICE: ROUTINE tl/ EMERGENCY
GOOD CONDITION tl"� FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER Vj�HER (EXPLAIN)
7
PUMPED BY:
E.N T S:
N'J'b'N'I'S TJ ANSI"E I Z R ED TO
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
r }ATE; µ y�
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example; left front of house)
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No
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DATE OF PUMPING: � QUANTITY PUMPED GALLONS
� CESSPOOL: NO
YES _ SEPTIC TANK: NO YES ,
IT
NATURE OF SERVICE. ROUTINE
... ,. EMERGENCY
t OBSERVATIONS.
GOOD CONDITION
HEAVY GREASE _ FULL TO COVER
ROOTS
_ ,,_ BAFFLES IN PLACE EXCESSIVE SOLIDS LEACHFIELD RUNBACK
'
'SOLIDS CARRYOVER--�__ FLOODED
OTHER(EXPLAIN) "`
SYSTEM PUMPED BY:
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1COMMEN
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THE PROFESSIONAL EXPERTS
IN THE SEPTIC AND
DRAIN INDUSTRY DAN
�c cE FORM 4- SYSTEM PUMPING RECORD .
Conunonwe th of Massachusetts
Massachusetts
System -Pumying„.Record
ystem Owner System L ocation
Date of Pumping:
�• �'f,. �` Quantity Pumped: �()(�llons
Cesspool: No Yes ❑ Septic Tank: No ❑ Yes /1
System Pumped b} :. .. .................................................. License,#:
Contents transferred to:
Date Inspector