HomeMy WebLinkAboutseptic tank - Septic Pumping Slip - 300 GRANVILLE LANE 8/9/2019 : Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumping Record AUG p Zo��
Form 4
TOWN OF NORT H ANDOVER
DEP has provided this form for use-by local Boards of Health. Othetft tiiM*T6i&ed,but the
information-must be substantially the same as that provided here. Before using.this form,check with your
Iocal Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left/Right front of house, Left/Right rear of housed fight Hof ho Left I
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address !;3 o(> 6 aimw� (/r fe �,e
/ /( I�
City town state I J\J Zip Code
2. System Owner. 6- /X_
Name'
Address(if different from location)
CitylTown Stag` ^�_3 to
a Code
Telephone Number
6. Pumping record C
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? es ❑ No If yes, was it cleaned? No
5. Condition of System:
A�' -ko 3- 5.4
stem 6. Sy Pum pedi.
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. LnLS.
1>ere contents-were disposed:
Lowell Waste Water
Signitufe clfHaulevDate
WbrmCdoc-06/03 System Pumping Record•Page 1 of 1