HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 623 OSGOOD STREET 8/24/2020 Commonwealth of Massachusetts RECEIVED
City/Town of
System Pumping Record AUG 2 4 2020
Form 4 TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
CEP has provided this form for use-by local Boards of Health. Other forms may be'used,but the
information must be substantially the two 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 jig—Kt front of house, Left/Right rear of house, Left/right side of house, Left
Right side of building, Le lg ro wilding, Left/Right rear of building, Under deck
Address
city/Town State Zip Code
2. System Owner.
Name" 1
Address(if different from location)
cityr'own stag zp code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. uantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes L 'No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Neil.Batesbri F5821
Name Vehicle License Number
Bateson Enterprises Inc'
Company
7. Lo w contents-were disposed:
G L S Lowell Waste Water
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HaWNU Data
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