HomeMy WebLinkAbout- Septic Pumping Slip - 314 REA STREET 5/13/2019 Ir
a dt V
m�
f
i
M
C*tyr""own
' NORTH ANDOVER MASSACHUSETTS
System h
V w piwr wwre,risa.� ,mod
.;� ecordlFarm 4
w.
Y
t
DF.-'P has ro i' 'e his form for use by local Boards,ofHealth. he System Vamping Record must 7
e s r tiru t d to the local Beard of Hey att or of-.her approving authority.
A. Facility
e�
I r i nt:
Whon filling out 1., 5"ystern Location-
fo�rryis w,the
computer,use Pc e c;.
only the tab key Address
to move YOU
rth Andover MA 01845
cursor�- to rjo - .� ., . .� n �. __ ... ....... _ ......
use the return City/To �� r Zip Code
key. 11- 2. Systern Owner:
a
Narne
Address if li f r rat fr rn location)
WTow ___
Zip Cf t ,
�._
ode
73/:yc
xe/ ,-3
. ._ �. . „
"Telephone Number
B. I-Funriping Reocord
I. Date Of PUniping
Date 2. QuanfityPurnped: Gallons,
Cesspool(s) Septic Tank El Tight "an
Other
4. fluent Tee iilter risen Yes No If yas, was it cleaned" El yes N
5. Condition, of tSystern-
1. System Purnped
Vehicle License Number
Wind River Environrnental
. —M
w Location where contents were na sa l
40
htt
m
l ,'/ .rri r ,). o o,�r/approve Is 5f)t*rns, m4ii sl t
o 6;L.� e rd Page I of 1
An
At