HomeMy WebLinkAboutMiscellaneous - 30 INNIS STREET 4/30/2018K---
H EAL T H
001-nmanwealth Of MaPsachusetts
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City/Town of
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1"r' systen", PumPij R, cord
Form 4 n 9
OCT 15 2007
TOWN Of
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has PPOvideck thi-s -form for U;S, by jaczl Boarjs of He
be sUbmined to tht� local Board,of Health or other approvalth, The,5ytitem plimping Raco r1a M
ing QUIhority,
A. Facifity info
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kay
2. ��Ysl:.Dm Owner- Zip cooik
Aodreatj (if diffe–fe—ni
Yli—y1fa—VIn I --
ale
s�
a. PU oing ecord — ------
Typi�ojlsy&am. oat Quaritily Pumped:
El c6-,,SpQ0J(,S)
El OthQr (dcsQ,-ibe): M/SePtic Tank El Tight T�ank
4- EifflUent'T6e Fiiteppre�atjt,�
c C1 Y',fs F] No if ye�, wQ,5 it cle��ned?
,5'- Of SY$tarn: yes No
6
Systern Pujnpr.,d By,
T
ROOTER -MAN
12 EAST DRACUT ROAD
painF_ METHUEN, MA ()1844
7. Location wjj,_��re
Wer'B dISPOSad:
Of Atru_&��F' f4_uc_(,� ------------
vIdepIw�,(ar/;�pp(,Qv,,
ms-htmtNpect
I =S/15for
�Ysreni Pumpiq . P,,Qe , I Of
ri
4 7 6 6 b;.- G' 4 7 6
HEALTH
C01*1711'no'.1wealth of Massachusetts
CP CitYJ own of NORTH ANDOVERI
� ",7
p
ENS,
syste
M Pumpirig Record
Form 4
RECEIVED
LTSEC 12 2006
TOWN OF NORTH ANDOVER
p Tm T
HEALTH DEpARTMENT
DEP has PrOVided this form for useft by local Boards of Health. The System PUMPing Record must
be submitted to the 10cal Board of Health or other approvirIg allthority,
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A. Facility
mation
jT71POrtant:
"'hen filling out 1 . - USYSWIM Locatiol)
fortris on tne
coilnputer, Ljge is
only the tali koy 764
to alove You(
cor'901, -do 110t
UZO the retwen Clt'y/Towr
key,
2. SYSte-M Own;��r:
ti �dre s _. Fif
State
Cie
Pu
rn*ig Record
'/ZUJ —
Date of Pumping I
2. Quantity Pumped
3- TYPe Of SYStern: 0 --septic Tan�
4 - Effluent'Tee Filter pres-ent? Ej YeS 0 No
5, Condition of Sy$tem,
Tight Tank
If yes, wes' it clealied? 11 Y8S El No
6. system P 'n ed Y"
ROOTER -MAN V il-L i —ce �STi.. _WL —ImTe—r
12 EAST DRACUT ROAD
METHUEN, MA 01844
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fm
7. Locatiotj ilyllere Contp_-nts we,'G disposrd
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lig
ig
http:/&WW Of'.i.-tv
.rtla$$.90V/dep/walter/appr,o-val$/tSfo..., D_iiii�
htlTiffinspect
t5form��.Jjoc. cievu3
45tern PUMP;,19 Record - Pagr__ 1 of I