HomeMy WebLinkAbout- Septic Pumping Slip - 121 ABBOTT STREET 11/26/2012 Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumpinz Record RECEIV'1Z
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System Owner & Address:
TOWN OF NORTH ANDOVER
Christian Sallni HEALTH DEPARTMENT
121 Abbott Street
North Andover, MA 01845
Location of system: Front yard
Date of Pumping: November 02,,2012
Type of system: Septic Tank
Gallons Pumped: 1000 gallons
System Pumped by:
Service Pumping& Drain Co., Inc.
5 Hallberg Park
North Reading, Ma
License #: BHP-2011-0413,0412,0411,0410,0409,0408
Contents transferred to: Greater Lawrence Sanitary District
Date: November 02, 2012 Pumping Technician: DD
This is PROPRIETARY and CONFIDENTIAL information that may
be used only by the Board of Health for regulatory purposes
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HEALTH
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DEP has provided this form for use by local awards of Health. The System Pumping Record
be submitted to the local Board of Health or other approving authority.
A. Facility In>Forma !on•�- _— --
xtant:
:n filling out 1. Systurn Location:
cuter,ure
the rab I+oY ,yddr2s8__...,.._,..�_._
ova your
,he return GrY/TUwn _— _
State Zip 4cla — — -- —
2. System.Owner;
5so K
Address if
different iYom to cation)
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Slaie '•—� •7i��, e
Telaphone Num4ar —
1. Date of Pumping
Date 2. Quantiry Pumped: U v U
. Type of system: Geuons
❑ Cessp4t►I{s) [J Septic Tank
,—J,/ El Tight Tank
L other(describe):
`t EfilUant'Tee Filterpresent'? Ye
❑ S ❑ No - !f yes,was it�le�ned? yes ❑ Na
S. Condition of System:
----
6. System Pul ed By: �—
Name KI
OTER-MAN Vehicle License Number
Company' 12 EAST DRACUT ROAD
METHUEN,MA 01844
7, Location where Contents were disposed:
Slgnaiu o auler --- 3
srww.rnass.Qpv/dep/ ataria rov Darr —
RF ais/11 f Frns.htnI inspect
t.duc•Od/03
�ystam Pumping Recprd •Page 9 Of•1