HomeMy WebLinkAboutSeptic Pumping Slip - 150 CHRISTIAN WAY 11/7/2017 A
RECEIVED
Commonwealth of Massachusetts
:City/Town of . NOV 0 7 t� I I
Syi�tern Pumping. .Record TOWN OF NORTH ANDOVER
rlNF.AL N
DEPARTMENT
Form Q
DEP has provided this form for use-by local Boards of Health. Other form's maybe"used,but the
information,roust 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.
A. Facll%ty. Inform' ation
1. System Loeatio htf@ f=house /Right rear of house, Left/right side of house, Left
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address vil
l C�
rit4,/"rown state Zip Code
2. System Owner: ,
-\j
Name'
Address(if different from location)
Cityl7awn State, 1—\
3� Code ^,
} Telephone Number
F,
. Pumping R-peord
1, Date of Pumpingpate 2. Quanti Pumped: Gallons
3. Type-of systerrt ❑ Cesspooi(s) eptie Tank ❑ Tight Tank
® Other(describe):
4. Effluent Tee Filter present? ❑ Yes o if yes, was it cleaned? ❑- Yes ❑ No,
l
' 5. Condition of System:
6.• System Pumped By:
Neil,Bateson ' F5821
' Name Vehicle License Number
_Bateson Enterprises Ina
Company
7. La onwu ere contents were disposed:
.,
.S. Lowell Waste Water
Sign a Houle Date
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