HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 720 FOSTER STREET 6/9/2020 Commonwealth of Massachusetts RECEIVED
City/Town of
System Pumping Record out 0 0 2020
Form 4 TOWN OF NORTH ANDOVER
�•• HEALTH D-EPARTMENT
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 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 house, Left®right side of house, .eft 1
Right side of building, Left/Right front of building, Left/Right rear of building, Under deCk
Address
citylrown State Zip Code
2. System Owner. V�"'q'e Vt
Name
Address(if different from location)
CitylTawn State��, t � Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2- Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Q-Seotic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System*Li-' 4� � f, �'�C V �� 1, �/ �
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc-
Company
7. Location where contents.were disposed:
G S Lowell Waste Water
'MoWue -
e Haul Date
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