HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 544 SHARPNERS POND ROAD 7/13/2020 Commonwealth of Massachusetts RECEIVED
= City/Town of JUL 13 2020
System Pumping Record TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPARTMENT
DEP has provided this form for us&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 forrim 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 i ht rear of housejeft/right side of house, Left
Right side of building, Left/Right front of building, Left/Rig TeW-6T building, Under deck
Address � p Cq �1��—` -- V v
CWrown ''T State Zip Code
2. System Owner.
Name
Address(if different from locafion)
Cityfrown ste*60 l �D e
G
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Type of system. ❑ Cesspool(s) tic Tank ❑ Tight Tank
❑ Other(describe):
d�
4. Effluent Tee Filter present? ❑ Yes Ej-N6 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. Location-where contentswere disposed:
G L S Lowell Waste Water
V
4S�ignitfufeHaul Date
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