HomeMy WebLinkAboutSeptic Pumping Slip - 7 FULLER MEADOW ROAD 9/26/2017 Commonwealth of Massachusetts
Cityffown of RECEIVED
System Pumping-Record
,�Y... Form 4
TOWN OF NORTH ANDOVER
DI=P has provided this form for uwby local Boards of Health. Other forma may,& ,�t�NT
information'must be substantially the tame 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 tQ
the local Board of Health or other approving authority.
. A. Facility, Information .
�Left/Right rear of house, Left/right side of house, Left/
1. System Location: Left K$lg rortt ofof house
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address + C `vJ._...
l P ,y `1
city/Town State Zip Code
2. System Owner.,
Name'
Address(if different from location)
City/Town State , ', (_ ip Caeo,
Telephone Number
. Pumping Record
<_5
1. Date of Bumping tate 2. Quantity Pumped: Lallans
• S
3. Type-of system: {� Cesspool(s) eptiC Tank ❑ Tight Tank
❑ Other(describe):
4.. Effluent Tee Filter present? ❑ Yes o if yes,was it cleaned? ❑ Yes ❑ No,
1
' 5. Condition of System:
VV
6,. System Pumped By: I
Nell.Bateson - F5821
Name Vehicle License Number
Bateson Enterprises Inc,
Company
7. Locat+ whe a contents were disposed:
1
G S Lowell Waste Water
4-AaaA.
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signA6 9t Haule Date
k5formCdoo•06/08 System Pumping Record•Mage 9 of 1