HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 37 SULLIVAN STREET 7/22/2025 z. Commonwealth of Massachusetts Town of NOrthgndover
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System PUMP'IrIg Record 2Q25
FGr'rTl4
Health D p p-�►� }
DEP has provided Ihis four, for use i)y IOc�ll [3MWs of HCahl). Cdther forms may�tie��qI lto
inforrnatlon must be substantially the sarne its that provided here. B0,10re using INS fOrril, check wish your
local Board of Health to detern-tine the (ornt Mey use The system Pumping Record rnust besubrnitted to
the local Board of H(331th or olherapproving aulhorl(y within 14 days from the pun)ping date it)
accordance with 310 CMR 15,351 _.-- —
HOUSE: iron bac' de rear le nfl
A. Facility Information --- BUILDINGi front rack side rear left (igi)t
mportant:When DECK: under
(Illing out forms 1. Systefrl L oc- tlon
or )ornl)uler,
use nl
p
y Yha lab 1- - - -. M-
uy to move, your Addre
r', th do not
f h A
c�. r e!u m -- —
Ke,Y. y l oven Slade Zip Code
2. SYStLrM OWneyr.
r,r Name _------.—
J
601
Address (If diHeraoi ((urn localion)
MA
Clly/Town aIt Z �-Code fwy
Telephone Number
Q, Purnpincg Record
1. Date of Purnping 0aalr. _ -- Quantity Pumped.- ._.-.---- --
Gallons
3. Component: ❑ cesspool(s) C ep(ic "Tank ❑ Night Tank ❑ Graaso Trap
(-_-) Other (describe)
el. Effluent Tee Filter present? (—) Yes (._� No It yes, wars it cleaned? 0 Yes o No
5. Observed condition P ( orr)ponenl purnpecJr
_ -- - -- Cam-- _. _-__ __
6 system Fli,jmped f3y:
Dave They Iviass IAA95E ss 1AD31Z
_...
N,ait�n Vehicle License Number
kew 1.n�erpf i ns, Inc.
C:orrrr�any
7. �L Mion where c nten s were disposed;
------ '
Slgnaluie of Haulei Dale
Sl�r�alure of f�ecclving FaallCy (or attach (nclllty reeeipl) Dale
6forrn4.dpc 11i12 .��'
y.sfernP(imping ficcord Prtge 1 pl t