HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 43 CANDLESTICK ROAD 11/17/2025 t � Commonwealth of Massachusetts Town Of IVOrth AndOver
Gr City/Town of
System Pumping Record 1025
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DEEP has provided this forn-i far use, by local Boards of Health. other forms may IJOTADtut the
informa iIion must be substantially thie sarne as that p(ovided here. Before using his form, check with your
local Board of Health to determine fhe, foe rn They use. The System Purnpincg Record must be submitted to
the local Beare of Health or other approving authority within 14 days fron) 'he pumping date in
acccrdarice with 310 GMR 1 5351
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filling oui forms 1. System Location:
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B, Pumping Record � y
1. Dale of Pumping _-� .__ 2. Quantity Purnped � � � _.._...._ ... ._.
D ile Gallons
3 Component. i_.7 cesspool(s) 4�eptic Tank ❑ Tight Tank F Grease Trap
Other (describe). _-_.__-- ---- __-- --.__.__ .._
4. FfflUent tee Filter present? _-) Yes No If yews, was it cleaned? ❑ Yes [� No
5 Observed condition of cornpone(nt (:urnped.
6 C'n'�
F- un-lped By.
Daverae Y Mass 1 �A05E- M�fss 1AD31L
_ ...._ _.. ..__
Vehicle l.feeoset Nmnber
BHA eson EMerI)rises, Inf:
C,ofrip any
Lc`caation wf;i�;re contents we"ie disposed
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Slyna4tife 0( 1 laulr r Date __-_. .._..-....._
Su�naturr3 �u( ka;cawlncl Facility (or atlach (,jcility rrcr,;ir>t} [�ralr
_.._
15(orm4.dOC 11J12 Systern Pumping Re(,oref fags 1 Oil