HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 414 FOSTER STREET 5/24/2021 Commonwealth of Massachusetts RECEIVED
City/Town of
System Pumping Record MAY4 202�
Form 4 TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
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, Left 1
Right side of building, Left/Right front of building, Le Right rear of building, Under deck
Address �,
lk�, 0 A -.,, fN
City/Town State Zip Code
2. System Owner.
Name"
Address(if diffenant from location)
CdylTown State t r r6 p C��/a
Telephone Number `C
B. Pumping Record _
1. Date of Pumping Date 2 Quantity Pumped:
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? 0,Y61EJ No If yes,was it cleaned? M-Y6� ❑ No
5. Condition of Sys em:
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7.ine
where contents-were disposed:
Lowell Waste Water
H Date
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