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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 18 PENNI LANE 7/13/2020 :�L\ Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record JUL 13 Z02U Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use-by local Boards of Health. Other forms may be �i '66MRAENT 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 authorlity. A. Facility Information 1. System Location: Left/Right front of house, Left/ �Orfe'aor Left/right side of house, Left Right side of building, Left/Right front of building, Left/ uilding, Under deck address i� � ``kA . City/Town I State Zip Code 2. System Owner. V� Name. Address(if different from location) City/Town State Zip�0 ^� r e�v Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type-of system: ❑ Cesspool(s) 0-1§eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo re contents-were disposed: G L S Lowell Waste Water --aGC_Z�© Sign We Flaul Date t5fomv4.doe-06/03 System Pumping Record•Page 1 of 1