HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 40 EQUESTRIAN DRIVE 11/30/2020 .&\.. Commonwealth of Massachusetts RECEIVED
City/Town of NOV 3 0 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 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 igh �rono
ft/Right rear of house, Left/right side of house, Left/
Right side of building, ig, Left/bight rear of building, Under deck
Address
UY/Town State Zip Code
2. System Owner. L
Name.
Address(if different from location)
CitylTown SW Zip Cade
Telephone Number
.B. Pumping RecordV- [6
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes Ly'No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System R,b
6. System Pumped By:
Neil.Batesbn F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location wl r ontents.were disposed:
L S. Lowell Waste Water
�6 �
Sign acfHtiulwU Date
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