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HomeMy WebLinkAboutSeptic Pumping Slip - 27 OAKES DRIVE 10/25/2017 Commonwealth of Massachusetts RECEIVED City/Town of t . I Sy' telll"1 Pumping.Record T.OWN OF NORTH ANDOVER Form 4 HEAL'11 DEPARTMENT I DEP has provided this form for use-by local Boards of Health. Other forms maybe*used,but the Information,must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the forrn they use.The System Pumping Record must be submitted,to the local Board of Health or other approving authority. A. Facility InforMation 1. System Location: Left/Right front of tions , Le i,12ig tear of ho we, Left/right side of house, Left,/ Right side of building, Left/Right front of bul Ing, Left 1�of building, Under deck Address City/Town / state Zip Code 2. System Owner: Name' Address(if different from location) cityfrown state1p Code Telephone Number . Pumping Keeord &- (7 1. Cate of Pumping Date 2. Quaon,ti Pumped: Gallons 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, 5. Condition of Sy to 7 6. System Pumped By: Neil.Bateson - F5821 Name Vehicle License Number Bateson Enterprises Inc Company J 7. Locafionwh9re contents-were disposed: j Lowell Waste Water IF Sign a(ftbuleV Date t ;5form4.doc•08/03 system Pumping Record=page 1 of 9 y",