HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 481 REA STREET 8/14/2025 Town of North Andover
�,dr`1'11"I1�JC�1Wec�lt�1 Of [\Aa5sa���"1�.�1�:',t�=:tts
hY _
Cifyl -own of AUG 25 2025
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Syster'T� Purrtpinq R�c(:)rd
m 1�r
Form 4
DEP has pmvided INS forrn for Me by local Boards of PICrrlllz- ()Iher lorr�ns may t)rr usec� , I)oi Ilrri
nlcrr'natiora r'nra , f:-e sr.ibstSanh ally the same as Mai pmviC ed hem, Refcarra i_,siog this, fr-,rrn, cr)eck yca11
lccW BoaW of Heals Io de,Ceumne the talon Ihey use, The Sy xlcm.n Pur ping Flecord nn.l,l A SSUbrnl(1C'.CJ IC
Me local €oard of Health r)r other approvtniI "rulhr:Wy willun 1 A days tenon Me pumptig t)ctle in
accordance with 310 CCMR '15,351
front ra
'g o'
A� Facility IrlfC)rr1'1c�tIOrI E�iU4t�CaIN�C1� frt�r7t b7r,k� ir�r Ir�fr�H,Irt"j
Ode �f'c�� 1(�f1' nf7Yrl
IrrYpor ank Whon DECK, under
Wig out forrns 1. Sy`,ter1 l.0 C�al.iofr
on the con1pulef
lose only Ma W ,
k"5 move yr.,,ur Actora1—
cwsor do nor
y o oil
t4rfrtrE,ss (If dificrnni frr)ra'i location)
MA
ceEyrrov�n - si l - -
/ir�Code
ryry s ,w,�
TelerSt�a'xitr MYimt�cri
1. Dale of ?.Pumping _ _ _ ___._ ...._ -
F C)aie Quan(ily f urnperi
.gallons
3. Component: _f Cesk,f,ony" 00"Ierylic 'rank (�_.f Tight Tank Gmmo Tm� ,
[] C)Mer (doscribe):
x ENluenl Teri Filter present? [] Yes QyTo If yes, was, k c9anedl (_._) Yes [.� r o
5, Observed condition of cornponent p per,1.
6. 13 r.,r8Anjl.1r71(7eCl By:
ave TPrrry Mras,s 1AA95E Mass 1A031Z
tame rlr•tYl(a r^ License nl,.l rr7 er
E Eason nf�rprisns, Inr� .�._ _._........�...µ�--
r_a
lion wkaere contents V"c re cli:3 s) cUr1.
�iG)raalurrl o Yt�r.rler (lralr
Slgnalure of rice ving sc,i ity or attach at,llil'y rr.ceiral) r7alq
5(c,rm4.rfcyr 11/12
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Sys(pfn PurYulinn r7,.,_ _, ,