HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 27 OAKES DRIVE 10/30/2025 Commonwealth of Massachusetts Town of North Andover
City/Town of
OCT 1 20
System Pumping Record 2° 25
Form 4
DEP has provided this form for use by local Boards of Health, r lul the
nformation must be substantially the sane 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 she purnping date in
accordance with 310 CMR 15,351, --- -
__ HOUSE: front ba k,,Fslde real 1r1. 1''rig�
A, Facility Information BUILDING: front hack .side rear left rigrl
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Telephone Nurnber
B P u r-n p i n g Record ----t--------- ------_ __ _-_---------------- ----
1 Date of Purnpinc P .--- ----..
Da-l-e - - 1. Quantity F umped'.
Gallons
3. Component: ❑ Cesspool(s) eptic 'rank ❑ Tank Ta Tight
g ❑ Grease Trap
Other (describe): -_ _..__..__ _--
4. Effluent Tee Filter present? [] Yes INo f yes, was it cleaned? ❑ Yes a
5. Observed condition of componer t pumped:
6 fy`Z-;Tt- PL)n-lped By
ave f InE C r
y Mass 1AA,�S�-' Mass 1AD311
- _--- -- -- - -- —- — ---- _..—...._ --arne vehicle License Number
feson Enterp6ses, Inc.
Company
oc if n vet _er; comenls were disposed
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Signature of Hauler Date - — -- ---
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