HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1080 TURNPIKE STREET 9/22/2021 : Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumping Record SEP 2 2 zo?,
Form 4 TOWN OF NORTH ANDOVER
DEf has provided this form for use-by local Boards of Health. Other forms mayIbaTus��SWQW
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. ig front of Flo , Left/Right rear of house, Left/right side of house, Left
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
City/Town lJ state Zip Code
2. System Owner.
Name
Address(if different from locafion)
CWTown state,
4 47 Ss I `-qc� P S 3%
Telephone Number
.B. Pumping Record 1. Date of Pumping Date 2 Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of Systerg: ��.AA_
`�
6. System Pumped By:
Neil.Bateson F5821
Name Vehide License Number
Bateson Enterprises Inc
Company
7. re contents-were disposed:
n-
S Lowell Waste Water
Bz6z_-O��
Sign We 91,libulefu Date
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