HomeMy WebLinkAboutSeptic Pumping Slip - 58 OAKES DRIVE 9/7/2017 Commonwealth of Massachusetts
_ C WT'own of .
RECEIVED
System Pumping.Record [4' 0 7 ?01
Form TOWN OF NORTH ANDOVER
DEP has provided this form for use>by local Boards of Health. Other forms maybe use u t
Information,must be substantially the same as that provided here. Before using.this form,check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority. t
A. Pacflity. Informi al#lon, .
i
1. System Location: Left/Right front of house, Left iaht rear of hoes , Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
nots
Cityrrown State Zip Code
2. System Owner: I
Name' f
Address(if different from location)
I
Cityrrown State Zip Code
Telephone Numbier -4
A
.B. Pumping record �
1. date of Pumping sate" � uantity Pumped:
Gallons a
3. Type-of system: ® Cesspool(s) Septic Tank ❑ Tight.Tank
❑ Other(describe):
4-. Effluent Tee Filter present? Yes ® Ncr If yes,was{t cleaned? Yes ❑ No
r
6. C ditlon of System:
deg
Vk� r �y ✓t �"' U'tt. �.!
6. System Pumped By:
Neil Bateson - F6821
Name Vehicle License Number
Bateson Ehterprises Inc-
Company _
7. Location where contents-were disposed:
CLS: Lowell Waste Water
Sign t e 9t HauleV Date f
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