HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 518 SALEM STREET 4/23/2026 Town of North Andover
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ity/_ own of
System Pumping Rec orci th Dept m ent
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information I mustkdf>e stjbstantially thf,"sarr7" as th.�fs of Other t provided here. BfIforle forms
sing 9hie> fsorrm, clrecl'�
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Board of Health to determine the form Wey use, Ct-te System Pumping Record must br„ to
the local Board of health of other a� rovio lutttr°,ril wi(hin I ,� days from the purnpinrt date,it)
Fp 1 Y
accord-ance with 310 C Mf 15 351,
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HOUSE front 2ar:I< I d o rr-far tt gh1
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A, Facility Information 8(JII,DINCF from biaM'- side rear IC�fI� it,w
mportant: when DECl<: under
(Fling out (orrw, 1. )ystefn l ot.:ation.
ml Ih o r ornputef,
w only lho lab .y� �R_ `�✓ _�".._4Gy Icr eawvo your !\rfrfr(
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System 0`'N r/.�
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B Pumping Record
'I, Date of Pumping 2 Cuar tilt' Purnped Gallons __
3 Component
( (s) ( � � Tight 1"_)nk
f �_-.i C;t 3F,:)<xcrl '��"�fiC (��r'iI< ..7 [_� CirF �iSE; �i�rrnr>
C7ther (describe) _ _..
/I. Effluent Tee Filter pro- .rr,ntn � f
w Y f r :> was it c;lr,arrc';ri l Yes, twdru7
5. Observed condition of col Iponent Ipurnporl
6 >yr ell.) un'tpaci fay
Dn eTf Ter cr - !
M a 1 if\) �E= mass 1 (731I
�% 'Vt�talr,lr L.i� r rti,,F•,. hJ rrrt�Crr �,
B� son E"r- r_prlses (nc.
Comlmny
7. Location Miele contorts w(-,;fe
Sic nrlluro of f fai.alor
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ttgr'ialt.irr, of Receiving f�racihty (or ,�Ilac;h (riCili(y rr�r.c�ip() (aalr+
(6forrnr3,r.oc, 11111 SysslG�rra f�r,rr�pin<� frt;curri r's�tar: t of t