HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 42 SPRING HILL ROAD 6/9/2020 .Yu\.- Commonwealth of Massachusetts RECEIVED
ammagannow
City/Town of 01UN 0 0 2020
System Pumping Record TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPARTMENT
DEP has provided this form for use-by local Boards of Health. Other forms maybe bsed,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 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,Ogg,
g rear'' f� Left/right side of house, Left 1
Right side of building, Left/Right front of buLLeftt� ar of building, Under deck
Address P " _ (`� ✓� ` (
Citylrown State Zip code
2. System Owner.
Name'
Address Of different from location)
CWTown �tate Zip�1-7�iOd �
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
Gallons.
3. Type-of system: ❑ Cesspool(s) 0-se—p-tic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes U1T0 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle t_icense Number
Bateson Enterprises Inc
Company
7. L e contents-were disposed:
G L S. Lowell Waste Water
Sign a Haulev Date
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