HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 99 HAY MEADOW ROAD 10/24/2025 TOwn
of Noah AndOver
COMMOr7wealth of Massachusetts OCT 2,1 2025
CityFFOwn of
Form 4
_k' her; ()rCrviCle,;d tf7i Farm
to a fc,r use by Ic,r aI r3ttmd 7 W t it 11(I� C.7M r for ms may t)c used,r'( buI Ihra
infort-nation rnu t (>r uf.Yslanlir Yly the snrr�r t P(Cmdr cf h rn Be(ore using Ihi; fou Check wkh You(
local Board of Health alth to dete nine the lornt Ihrry use f h(,, Sys(ecn Pumping Reccsrc'1 rnus( be's(.(mined to
the local Board of Health or other aPprr7ving vwi(h n '14 clays from the pumping date in
accordance with 310 CMR 15 351 .------
}-0USE: front lack ,ide�rnr lee p,h
A . Facuity Iriformatlon BtjtL DIN G franc back side r(.3r lee qI)t
(nnprordanCwlrarr DECK: J("der
.; rl.
ng
on HIP (�orn 7i.rkFa(,
allele <�nlEat 4lu�rm�b lPrfY`1
fay to move vow A d d f o s;„ _...... _.. ........- _._
cur."or do((ol
se. 6he ro(�r(n rAA p
hcy ait, Zip cone
(� 2. �Systern Owner:
Arictruxs (II clirfere(rl morn location)
- -
_. MA
---------------
olale zIr>cor1c�
elepYion� 1-'
fvurr(lar!��r
B PUmping Record
1. Date of Pumpioc �� 4r �� _ .--- 7 Quar)My P(in)peci: �� _
Gallons
3. Cornpor)ent: e,sF,r)ocI s _ Se ftic Tank
right Tank ❑ Greases Tral.Y
Other (describe): _.___- _.._...._ �.. __._. _... .. .
4. Effluent Tee Filter f)rns(.-,,r7t? (_�� Y�s NC) If ye<>, vUa t c Ier ioed e s (_] �q
Observed condition c:)f cornprfien( pufn( ed
6 System Fear -need By
Dave TI(le Mass I At E Mas �(AI Z
tJ�rm2g VcYlt,lc Liccn,,t, Number
kesnn F nk vjj6nf , Inc
carnpafny
7. Lo 'aliun whore contends w fr') dispu;c'd
Slcgn.flwe of li7(_ller
w>It�r(alUr O( ftaGc;lvinc?} t34,ilily of anaol faciwy r(:ctti y1} Oale ---
TnN,cloc 1'1111 yy:l n7 raumf,rin�R(,'co(rt Pa(l(,� 1 rai 1