HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 465 CHESTNUT STREET 7/15/2025 Con-ir-nunweaIth of Massachusetts Town of North Andover
�r , "� City/Town of
_ ___----
Syst r77 Put Record JUL 21 �2025
Form 4
f y � � (Dep ut the
C�F;f�=� has provided this form for usn Ir Ir��cc31 C3or�rds of F1eGalth. �� (�
ntormahon must be sL,ibstaMiall! (he s,-.irne as lh,'Al provided here. Before Usfn� el (he
with yot
local Board of F-ea(lh to determine O)e fofni llley use, The System Pur-raping Record must be submMed t
they local Bogard of i ir:,�alth or other approving aUll'ority wi(hin '14 days from 'he purnping elate In
accordance with 310 CMR 15 351 - ---- _ ___.._ ......._....
HOUSE front ack. side <e—a'r,e I ft
A. Facility lnforrT atio(1 BUILDING: front Back side rear left
frnportant;WhorY
CHECK: under
filling oul forms 1- `-7ys(a rn location:
on Ilse con? utei,
use Only the�ab
key to reeve y<o,ur 11UeSr sv "VET - ..._._.....__., _
t;ert SC)r -r:16 nUl
use lh(e' relu(n -
key,
y Slate p ocie
7, SSterri Owner
cow
A,ddreas it dif-fe(o t from Iocallon)
MA
Y >i3ta. Zip Code
Telephone Numbe!
B. P u r n p i r7 g R e c o r c
Da(e of PurrtlDind Date — 1 Quantity Purnpeci: _._..____._...
G ans
3 Cornponenl� [ ] Cesspool(s) c 1`ar�tk Tank Ti hl g �_] Grease Trap
❑ olher (describe) _.__._. _-__ _..__ ... . ._ __ ...._ .__.
4 Cffluent Fee: Filler Icr, sr3nt > [_] 1'E,s [- <o If yes, was i( cleaned? Yes No
OhsceiveC1 condition of C:c>rrrponce
6. Sys(ein Purnp ed By
(v, ,r Mass 11-1A9`7� "ass 1l�D31Z
Vehicles License Nu nt7e!
PS Inc
.�, _.......
7 Loca(ion wheyrF, c,on(ents were Ctisfrc"ised
_-011 11r alurt; of h1 .r _ C7alc
_._
SlyrtkYlurr, of Rere.iviny r acllily (o( allarclY facility rr;ccipl) CJa1e�
5(orm4.tJpC t1J12 Syslen)Purnping Record pacfr, 1 of