Loading...
HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 29 NORTH CROSS ROAD 9/7/2021 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record SEP 0 7 2021 Form 4 TOWN OF NORTH ANDOVER 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 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/ t rear of hou Left/right side of house, Left Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address a_ .C�c� City/Town State Zip Code 2. System Owner. Name. Address(if different from location) City/Town State Zi Code ��3-�'?© -�` SAC Telephone Number B. Pumping record Qz,a 1. Date of Pumping 3 �2 QuantityPumped: Cate p Galleons 3. Type-of system: ❑ Cesspool(s) M,56ptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? Yes ❑ No If yes,was it cleaned? es ❑ No 5. Condition of System: 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Ina Company 7. Location where contents-were disposed: SZ�2 Lowell Waste Water cM raOA. Sign a HbulerU Date t5formCdocr 06103 System Pumping Record•Page 1 of 1