HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 90 LOST POND LANE 7/18/2025 C;omn-ionvvealth of Massachusetts TOWn °fAlort
City/Town of .. _— h4ndover
System Pumping Record
r F o rr-n 4 AUG20 5
DEP has provided this forr7-r for use by local Boards of He:altI 'Pl t aLbr o used, but the
nformalion must t)e sl.,ibstantiall the s@nne as lhat provided here. Before u IF?jT I' �' check with our
Iocad Board of Health to determine they forrn they use, The System Pumping Record be tie submMed to
the local Board of Health or other approving authority within 14 days frorn she pur�nping mate In
accordance wlkf7 310 CMR 15 351
HOUSE: ror back side rear (2� rif
A. Facility information BUILDING, front back side rear left rip
InsportanC Wh
DFCK: r,inde1,
filling out forms 1 Systern Location.
on the cornputef, //
use only the(ab p0 4/�0j T CJ�'10
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key Io move your Address
uses) deg not etutri �(/ MA
key C I(y/r0"n — - Slate Zip Code
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2, Systern Owner
tel�rfl
AUdross (If different frorn location)
f\A A
(.IlyIT own J18 to __-_ ..__._-_.....�....._.._......._..__...........
� � Lip COdid
Te,iwphctnra PJurni7er
B. Pumping Record r
1. Date of Purripir7c � f ------- 2, Quantity ('umped
r-gale Galic ns
3. cornpof)ertt. ( Cesspool(s) Septic, Tank Tight Tank o] Grease Trap
❑ Other (describe) ______ ___ _ .._
4. Effluent Tee F-Iter present? [ � Yr;�s [ _ NO If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of co IT��onent T) mf,aed
6. Syslein F urnped By: i
puvu l ineY MfaSS 1Af��SS ass 1AC'31l
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PVarru� Vehicle, License Numb
E3akeson E nterprisps, Inc.
C<rn�{zany
7- L , n wr"iere contents were disposed
GL5 .
Signalurt, of Hauler Date
Siyraature of Rec�ewlny Facilitry or aCl.ar,h Gse;ilily (rsc;r,if:>t) Date
5(orrr74.d 4 '11112 ,33ysl rn Purnping Record Page "i of t