Loading...
HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 950 JOHNSON STREET 12/16/2020 Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record DEC i 6 2020 Form 4 TOWN OF NORTH ANDOVER DEPAr— 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 ht rear of hou . Left/right side of house, Lett Right side of building, Left/Right front of building, Left/Rig rear of building, Under deck Address City/Town State Zip Code 2. System Owner. Name Address(if different from location) Cityfrown state Zip Code C � Telephone Number B. Pumping Record 1. Date of Pumping Dam 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes © --9�0 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 contents were disposed: _L Lowell Waste Water SignLW Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1