HomeMy WebLinkAbout- Septic Pumping Slip - 194 OLYMPIC LANE 5/13/2019 /r/
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City/Town of NORTH ANDOVER VJ`71 A �S A C H U E I`T S
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' �System Kid r a
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Perm
DE"P has d tliils i4r m f r use by lacal Boards of Health. The System
e submitted he local Beard of Health or other approving authority".
A. Facifity hriformat'
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Importa nt.
Whian filling out 1w Syster i I- tr ra
forms on the
mputer,use jq_
only the lab,key address
to move your
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r AndoverMA 01845
use the return O not
City/Town State ZIP Code
. S st rn Owner*
*
�t l Zi- C,de
3
"el ply r l ai r
B. Pumping 1e
ing Sao
Gallons
. Type of system: El Cesspool(s) SepticTank Fight Tank
Other(describe):
4. Effluent Tee Filter present? j yes If es was it deans
5. Condition of r3ystem,
6. Bata PUmped
Vehicle License Number
Wind River Environmental
Company
T, Location where conlents were disposed:
APS T
WIN
nature re of HaUl r Date
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