HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 67 VEST WAY 5/3/2025 Town of North Andover
Commonwealth of Massachusetts
City/Town of
MAY 9 2025
System Pumping Record
Forr-n 4 Health Department
DEP has provided this form for use by local Boards of Health, Other forrn.5 may be used, but the
information rnust be subslanlially the same as lhat provided here. Before using this form, check wiih your
local Board of Health to determine the form lirey use, The System Puni Record rnust be submitted to
the local Board of ldeallh or outer approving authority within '14 days from -.he purnping date In
accordance with 310 CMR 15.351
HOUSE: front back side Cal, I rig
Cr rear
rig
A. Facility Information BUILDING: front back side rear left
Important:When DECK: under
(Wing oul i I S st I b-,)cation
on he cornpulot, 2,
use only the tab
key to move you( 4,0, e 5
cwsof -do nol fV1 A
U'se the (etum sla�e P ode
key lyf own ZI)
2 Systern 7w0er:
Name
I y)-\
Lin--AXI'�"'
Address 'd'-!,T f—er e,nT-f o-n-'�--Ilo--c-a-i—Io-n-)-,
MA
to( -_-i o-d-e--,—
Telephone Number
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B. Pumping Record
1, Date of Pumping ate 2 Quantity Pumped
3. Component'. ❑ Cesspool(s) nk ❑ Tight Tank Grease Trap
t V0 her (describe):
4. Effluent Tee Filter present? Yes J No If yes, was it cleaned?? Yes [3 No
-
5. Observed condition of cornponent purriped
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6, Sys(ern Purnped tiy.
Dave -Finey_ Mass IAA95E Mass 'IAD3'IZ
Nbrrte Vehicle, License Number
Baieson Enlerprises, Inc
Company
7 Localion where contents were disposed
GL5D
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S I o n—a l-u-(o-o",FR—e-c-�' 1 r n 9 F a c i t y (or a Ha c l i I a c i I(-y i p I)
Syslern Pumping Record Page I of 1