HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 456 SALEM STREET 12/9/2025 <� CCornrnonwealth of MasYsachusetts Town Of IVOrth AndOVer
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Syste m Pumping Record
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DEP has provided this form for use, by local Boards; of Health, Othr�,r forms r71a, he,
info(rnation rnust t-)e substantially the sarnt:= as that p(ovided her�,f Before using this farm, check with your
local Board of Health to determine the form lhey use The Systern Pure-ping Record must be subrni(ted (c
the, local Boarci of Health or ottir?r a:r proving at,Ah-Iori( within 1�I c'Jays from he purnping date ort
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A. Facility Information BUILDNG: front back side rear left
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B, Pumping Record
I, Gate, of PurnpincT � to Quantity Purnped� C>a�S
3 C on)por)ertC. (,...,� C ssr rrcrf( ) [ peptic Tank [ ] 'fight Tank ( ] C reps Trap
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0 t i 1 e r (describe), _---.
4, Effluent Tee Filter present? (._) 'Yeses[ ''No if yes, was it cleaned? 0 Yes 0
5, Observed condihon of (cornponent pun-)ped,
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