HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 98 FULLER ROAD 12/30/2025 x UOcTIITIOnvvealth of Massachusetts Tow f 'N,orth Andover
G i t y/yl o w n c�f
System PUrnpincg Record JAN 2 8 202
F o r rn 4
f)E1''=' has provided this forrn fo; usew toy local Dc>atds, of liealIh.
nforr-naflrtn rr'ius;t be sutrst anlially H')e s@rne a,s tha( provirded here, Before using this form, chock with your
ocal Board ref Heswalih to determine the lorrrl Carey use The Systern fr'urnping Record must be st.rbmiltterd lr_r
Me local Board of Health of other s3pproving ar.ithority within 14 days from 'tre purnping cdafe ir-1
accor&ince with 310 C MR 15 351, -------
HOUSE: iron b ck side rea 1c?ft
A, Facility Information BUILDING: 6r70—nt knack side rear left r
Important:Whrern
DFCK: n d e r
(Illfna oul forums, 1- Systern t 0C�' 10(I
oo the cornpulr�l,
u;et only the latz
koy to move yod fVd<�"s
cursor do n<71 I(Ut" �'`�, / f u1Fy
use lI'iCi �e(uin _ r..-.`lt..... __, .._ _,.._....,..._ _— _,...._.,_.._,. --
key. C byfrown S6,af Zip C,ore —
21 Systrarn (anrrrr r
cairn
_.
lsUdlciss (II dif(Grfynt I(vrr-, luc',uailon)
MA
Iyflown r
liir Code
Telephone urnber
.. __...._._._.. —-- - .... ._
B, Pur ping Record
1, Cute of Pumping .� .-._. .. -- 2. Quantity Plumped, �a
- Ions
( f (s) f [ 1 ri9t7t Tank [ ] Grease al;r
3. Corn 0()enI: Cesspool(s)>o«I e tir."tank
l:)Ihe( ((Jescribe)
r-.1 (_� [� No
4. lv(�fl�.3aent "lee Filter f;>rfr3sr:nC? ( ) Yes No If yes, was It r;l�aned7 Yes -
5 Obseived c(:)n ditio(i of cornpo er pt,'w
J
6. ys(errl PI-)rnped 43y.
Pave....t In 'Y__... _. Mass 1/a,A9SE Mass 1AD31Z
�41.arntA Vr1)ir,lr; t,lc,r,nSe. Nuns rr
3r�l Q,rDn .:n�orpnses, Inc
Corn y
7 c
whlCr c y�4;'N1fic3r
Sic natur; of f(�arrlcc _
J C7r�te; -- _.—
Slgnaterro r>I_R e;e,e,iv �scilily (or <r(I ci'i Iacility ra er;ihl) Daly
"7
5larm4,r1 w 1'iPi 2 `3yslern r'innping Record t),3 ge 1 of 1