HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 345 RALEIGH TAVERN LANE 4/24/2026 _,ommormeaitl-i of Ma,»2chusetts Town of Noillh Andover
E Y iF
City/Town of AFAR
2026
System Pumpinq Poc;orci
Department
D I' has provided this frarrr7 for use by lou.,�rl Bo tdr ,, t-)f Hes�tllh. Other fOrrns may be used, but fe
inforrnration must be substantially the r ar-ne ,,1s tha< pfovit9ed liefe, 13efore; using lhls forn7, yr>t.,r
ccal Board of Health to dete;rrnine the four llr( y rase:. The System Pumping Record must btu SuLrr77ittr��(J to
the; local Board of Health or other approving r+utlrr:7r'iPy v M-)in 'lr1 days fron) the pur�nping date;lr7
accordance with 310 C NIR 15 51
A. Facility �r1CJrt11�3�1Ot1 _ . E3t11t�(7IwC; (rr HOUS� nr htl�,l< ;In rr�tl, ft r' ht
-- rrt tra li side ,e�a, Veh nf,t)�
lmf)UrtanC w)ef) DECK: ur'7Cat:;'r
(fIllnrl oW rorr,)r, 1. system G o .9tic
use o rl l y t h o I a b �t - --._.-.,_,_. .__._..
key 10 move,yn,,rr Ac't o!zs
r,r sor -cir3 rrraV - Clc /...., f C\
u,r� the l e t u r n .._....._._ _.. ,.._. .. fl__.---- - .._...__._.... _.......-. _ _. .._......._ .... ..
key, C ilylfrxwrr _ �,ric Zip Carte
�r
l synrrt C)wrrc
. .. ..._.. __.
F�cJdr�rss (i(di(ierenl morn Iracalion)
NA
Cify�l'av�n ,31 fl p C";rxJ(' _
l - -
1 eiC,P rc nc f lurnbe,
B. Purriping Record
s
1 Date Of Purnping 4 .-=_: - 2 CauanCity purnped.
gallons
3. CCc>mponent C_1 C;r a:atr�c>( >Iic; Tanst
f;; �.„„.�"( �. .7 �t. Cs h( 7 �)n k (_ 3 rep s r3 .l.r-r f'>
(.`_) Other (describe):
4. Effluent Tee Filter present? _..) ` (C (_._ o If y(Is, was it (,,4e)nee? Ye,
5. Observed condition of corny )e t pwnpe -
s t e n-) Ira a r-n p r�,Cd,,(3 y
a v e 1 PnE;y._.._ .. . Maps 1A.A95E� Ni�ss 1AD3'1l
f7t E" 'V t;hlr l,, f_i(.t-rr,,* t1,u-nbrr .,.. .._.._
eateson nterprlses fnr
r"ornl7r7r,y
Y. l_ac tlGrl h€;rr,lc )n =..l we'l dispo;')cd
. . ..........
nalmo of f lauler -
lglYaltJrr, of Receiving cr oility (or ill rCh (<roilily rc;t,oipO
fCXrM.11ac 11I12 ysl(=,rrr Gaurrrpinra RectrrCl