HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 275 ABBOTT STREET 4/10/2025 Commonwealth cif Massachusetts Town of North Andover
City/Town of
SYStOMPUMping RecordAPR 15 1025
Form
DEP h roarid
info p thiftirm for,use by� Boards of Health.
n ion must be substantially as that w M
of Health to determine i arm hey u provided
a System
Pumping Re chid��°rsrst check with your
Board of Ht�iNtt or other aRecord must be submitted to
accordance with 310 CNaR 15.351. � y thin 14 days from the pumping date in
A. Facility information
b hams t When
Ming out form 1. System Location:
on the cornputer,
use only the tat,
key to moV9 your Address
cursor a 40 not use the return r 1rr y
key, Citylrown — _ __
. System Owner:
reiephone
B.
_ _..
Puraping Record . .. . ._,....� ..
I. Gate of Pumping
ate
2. Quantity P'urrh
3. Component:
a�iBan
0 C i{s) [� Septic Tank n 'Tight Tank grease"Crap
El Other(describe):
4, Effluent Tee Filter present? 0 Yes Q No if yes, was it cleaned? El Yes CJ No
5• Observed condition of component punt
5. Sy tem Pumped By:
i 7 � i` _. �
Veth.__.-_._ se tutu;
Cwnpany
7. L.zwlon where contents were disposed:
_., m 1
a ah ZK�
Hauler _._...
ate ____.____
Snature of ty(are
t rfarnK ce 11/12
system Puniping Record•Page 1 of I
i