HomeMy WebLinkAbout- Septic Pumping Slip - 146 DEER MEADOW ROAD 11/5/2018 Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumpling Record
NO
Form 4
"TOWN OF NORTH ANDOVER
DEP has provided this form for use-by local Boards of Health. Other forms rl*MMAAbame
information-must be substantially the tame as that provided here. Before using.this form,check with your
local Board of Health to determine the forrh they use.The System Pumping Record must be submitted toy
the local Board of Health or other approving authority.
A. Facility In far Mation
1. System Location: Left dGEro:n t;:o:fhou ," Left/Right rear of house, Left/right side of house, Left,/
rout
of S Right side of building, Left/Right ront of building, Left/Right rear of building, Under deck
Address
city/rown state Zip Code
2. System Owner:
Name'
Address Of different from location)
Cityfrown z�ip Cede
Telephone Number
.B. Pumping 9c®r
1. Date of Pumping Date a Quu Q
2, ty Pumped: Gallons
3. Type-of system: E] Cesspool(s) Septic Tank [:1 Tight Tank
Ej Other(describe):
4. Effluent Tee Filter present? M'_Yes E0J No If yes,was it cleaned? D—ye—S-13 No
5. Condition ofSystem:
6. System Pumped By:
Nell.Bates7on F5821
(dame Vehicle License Number
Bateso i Enterprises Ina
Company
7. Locati tents-were disposed:
!�_l�_ _ I
GILAIQ' Lowell Waste Water
G ISIgn 0 AHWe Date
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