HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 315 CANDLESTICK ROAD 11/19/2019 : Commonwealth of Massachusetts RECEIVED
City/Town of Nov 19 2019
System Pumping Record OF NORTHANDOVER
Form 4 T�HEA,LTHDEPARTMENT
DEP has provided this form for use-by local Boards of Health. Other forms may be used, but the
information,must be substantially the same 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 to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location e g �houLeft/Right rear of house, Left/right side of house, LeftRight side of bulgy ' , Left/Rigding, Left/Right rear of building, Under deck
Address r—
city/Town State Zip Code
2. System Owner.
Name"
Address(if different from location)
Cityrrown zi
Telephone Number
B. Pumping Record
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? ❑ Yes o If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of Sjrst�tn:�
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Ina
Company
7. Lo er contents-were disposed:
7G L S Lowell Waste Water
Sign a4tHaulmuDate
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