HomeMy WebLinkAboutLawrence Airport - Septic Pumping Slip - 492 SUTTON STREET 8/11/2025 Commonwealth of Massachusetts
City/Town of No.Andover
wn System Pumping Record
Y � g
Form 4
DEP has provided this form for use by local Boards of Health. Other farms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information -Town of 1V01thAn
Important:When aver
filling out forms 1. System Location: / r~✓
on the he tabcomputer, �„ / % ,e` AUG
use onlythe tab
key to move your Address
cursor-do not
use the return ---------_.__ _-.____-- ___.
key. City/Town pC��de
n t
VQ 2. System Owner:
Name
iennn
Address(if different from location)
No.Andover MA
City/Town State Zip Code
Telephone NurT°iber
B. Pumping Record
1. Date of Pumping Dat _.__.. 2. Quantity Purreped: tali,'Cs
3. Component: ! Cesspool(s) k eptic Tank { 11 Tight Tank -� Grease Trap
j Other(describe): - -.. ... -------_._--.--
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? J Yes L] No
5. Observed condition qf component pumped
6. Syste um ed B
e
Name Vehicle License Number
Stewart's Septic 58 So Kimball St , Bradford,MA
Company
T Location where contents were disposed:
20 So.Mill St.,Bradford,MA
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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