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HomeMy WebLinkAboutMiscellaneous - 27 OAKES DRIVE 4/30/2018RECEIV60 Commonwealth of Massachusetts City/Town of OCT 2 1013 System Pumping Record TOWN OF NORTH ANDOVER Form 4 L HEALTH DEPARTMENT DEP has provided this form for use: by local Boards of Health. Other forms may be 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 form 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 house,/tVeRight:ngg�, Left/ right side of house, Left/ Right side of building, Left / Right front of buMffing, Left / Right rear of building, Under deck Address P Cityrrown state 2. System Owner Name Address (if diftrent from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system*-. Zip Code lZin Carle Telephone Number 2. Quantity Pumped: Date Galions Cesspool(s) 0-tieptic Tank El Tight Tank El Other (describe): 4. Effluent Tee Filter present? F1 Ye.,s a--N�o If yes, was it cleaned? [] Yes E] No 5. CondiNon,of System- (Ie� � 6. System Pumped By. Nell Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. L re contents were disposed: nZ rGL L, S. Lowell Waste Water P-17- t3 uleq I Date t5form4.doc- 06/03 System Pumping Record - Page I of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key - VQ Vk'& Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 IV E C SEP 14 2007 I TO'�AIN OF NORT9 ANDOVER F,F,�,, i. i� IQG DEP has provided this form for use by local Boards of Health. Other iorms may 6�'u &thd 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. A. Facility Information 1. System Location: Cityrrown 2. System Owner Name Address (if different from location) Cityrrown 0_C 0 Zip Code state,,,, Zip Code (Z) Telephone Number B. Pumping Record 1 . Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: El Cesspool(s) E3-SU-pffic Tank [7 Tight Tank El Other (describe): 4. Effluent Tee Filter present? El Yes If yes, was it cleaned? E] Yes n No 5. Conditi n System: M� U�-� 6. Syste P ped Ely" Name Company 7. Location "re contents were Vehicle License Number Date -t t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 OF NORTH'AUDO VER' :"SYSTEM PUM,pl -NC PACOR-D ,.,V�.TEM QWNFR ADDRESS r IV- 4� SYSTEM L6-C—;-A—TI0N--- front of hou�t) ,/34-6K QUANTITY PUMPQ- D Avd( C"A L L s 1, o o L: N 0 SEPTIC T ANK: NO.— YES N.ATURE OF SERVI.M"ROUTINE. EMERCEN'CY I j r R YA T 10 N S.,-. FULL70 COYC- k. .8AFFLL �S IN 1) LAC R 0 LEACHFIC iLl) RUNUACK., CXCESSI.YE% SOLIDS**: FLOO-DW "'C R Y�0,y L, Im c b I 'PUMP 0 Y:' "I -,y I r�, N T S: RU, D T01, Commonwealth of Massachusetts Cityfrown of System Pumping Record Form 4 FOCT 3 C Lu;u9 DEP has provided this form for use by local Boards of ealth. Other for a used, but the a t0h ri 'c y 'y OF J r a - ng thi form, check with your information must be, substantially the same as that pro'bM -% je�#, local Board of Health tQ determine the form they use. ihe-9j-'s1e6"-PGr"Wing ecord must be submitted to the local Board of Health motft6r approving authority. A. Facility Information 1. System-LoGatiQn: Left side of house, Right side of house, Left front of house, Right front of house, Right rear of house. Left rear of building. Right rear of building. Address D`7 Cityrrown State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: El El Other (describe): State Z' C de Telephone Number Quantity Pumped: Date Gaillons Cesspool(s) e—Septic Tank El Tight Tank 4. Effluent Tee Filter present? [j Yes If yes, was it cleaned? E] Yes 0 No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed.- G.L. D Lowell Waste Water Signature of Hauler F5821 Vehicle License Number �0 1) (-(:D� Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts COVED City/Town of FR System Pumping Record 1 Form 4 T Tnw OWN OF NORTH ANDOVER NORTH _�92�ER DEP has provided this form for use by local Boards of Health. Other g rrrsan i . information must be substantially the same as that provided here. Be re 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. Facility Information 1. System Locatio * ht front of hous<1L-e-'V" RigKJLea� -of �hous eft / right side of house, Left I Right side of buVii Veft'gj/ Right front of building, Left / Right rear of building, Under deck Address �D- V-� Cityrrown 2. System Owner: Name Address (if different from location) Cityfrown B. Pumping Record 1. Date of Pumping 3. Type of system: F� C) State Zip Code State Zip Code Telephone Number to -'�!) (b — k k Date 2. Quantity Pumped: Cesspool(s) Er'S—eptic Tank El Other (describe): 4. Effluent Tee Filter present? E] Yes a -'No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company Gallons El Tight Tank If yes, was it cleaned? E] Yes El No (-Q�LeA 11\ (I\.- -4��� 7. Locati hei� contents were disposed: G.LS.W- Lowell Waste Water F5821 Vehicle License Number I Date t5form4.doc- 06/03 System Pumping Record - Page I of 1