HomeMy WebLinkAbout- Septic Pumping Slip - 141 REA STREET 5/13/2019 "?)E"(1
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Commonwealth of W-)ssachusett
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A� Systern Pu,,rnp1n,,g Reword
IF
Form 4
has providodthis form for use by local Boards of Health. The System Pumping RecoM must
be Submitted tothe local Board of Health or other approving a rji ,
A., Facility InformatilOrl
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When filling out 1. Systen .ocation:
forms n the
computer,use /4//
only the tab key Add'ress
move YOU, North Andover MA 01845,
cursor-Rio riot ��� T r �_ _.._ _...._:.. ._.�� �..:�..�.�......w..mm_,..�_� �_�� ..� _ ..��.
use teas return, � ��t�l. Zip Cod
key.
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Address(if different from Ion-Aion
Stalelip
'T��Phone Number
B. P' Unnp'111191 ReCord
µ Date of Pul"ril'),ing
t t Gallons
3. Type of system, E'l Cesspool Septic Tank El Tight Tank
. EffluentTee,Filter present? Yes [efNO If yes, as it n Yes El No
6. -System Pigs By-
Marne j
Vehicle License Number
Wind River Environmental
7. Location where contents were disposed: 40 S Porter St
Bradford, Ma
('978)
sin ,t r dallier atl
p; www.r i ,si.g (r I pp v is o rrrr tmgi'raped
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