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Dlrp has provided this form�for use by local Boards of Health'. 'Phe systeM'_'__'_'__P Record must
be submitted to the Ioaal Board of Health or other approving a thorl'ty. �'
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System Pumping a Page i of t
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD � � � ��, � ��i�P
DATE:
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: loft front of house)
DATE OF PUMPING: _ _ - QUANTITY PUMPED 1,560 GALLONS
CESSPOOL: NO X, YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE 5 EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY: '� r �J � ?�
COMMENTS:
CONTENTS TRANSFERRED TO:
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