HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 474 SALEM STREET 12/9/2025 To wn Of&'Orth
`\ Comn7onweaith of fr.Aassachusetts Andover
G, C;'t y/Y1 o w r7 c:a f DEC 15 202
S stern Pum inc Record
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For Ilea" )6Partrn
DEP has provld(sd this form fray use. try local Boards of Health. Other forms may be user, bu
inforr-nahon must be substanlially the sai-ne as lh,-R I'>rc>vided herc-2 Before using lhiq, form, check wflh yom
local Board of 1-IeEallh to determine tale fo(rn they use The Systern Purrlping RE co(d r-nust be submitted lc
Me local Board of Health or othc,,r a{.pr oving <:aulhority within 14 days from she pur'nping date ir�l
:accordance with 310 Cf\AR 15 3`)1 _._ ._---- --------
HOUSE: tUr' back side reG1r4!k='9
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A. Facility inforr-natiol7 BUILDING i front l-)a('k side renal, left
Important:When DECK: LJnC�P.I"
(Ming out lorrr'is 1 `iysten"i Loc;rl((iof%,
1n the ly(haul 1,
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kHy to rnove,you( Addross
cursor -do not
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B, Pumping Record
1, Date of F urnpiny — _... ---- - 2. Quantity Pumped ---
Dale C"saII f)S
3. C; rnpranc nt. (_._} Cesspooi(`s) '� Septic Tank [.� c�(al Tank (�_) Grease -(rap
(_. Other (describe) _..__. _.___ ---.._.__ -._______-- ___—_
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�1. Ev�.f�fiucsnt Tee Filter F)r�,�senf? ye
s c� El NO If es, way, it c',i��nec1l Yes [3 No
5 Obsefved <con(Jj (oon of c mpCanF-;nl f:>�.rrrlped
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t) S era-r Pur-riped By
06 Ve-T Inc' Mass 1AA05 Maass 11a,C)31Z�
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