HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 20 COLONIAL AVENUE 3/19/2026 Town of Nowl
C,omrnonwealth of Massachusetts Andover
City/Town ofMAR 3 0 2026
System Pumping (record
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DEwP has provided this forrn for use by local E3oards of Health. Other forms may be used, bul the
inforrnation rr us( he sut)stantially the sAf-ne q� 0-)at providad here, Before using this, forum, chAck with yoUr
local Board of Health to determine the four they use, The System Purnping Record must be submitted to
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the local Board of Heailrh or voter Approving aulhority within 14 days from -,he purnping date in
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A. Facility Information BUILDiNGi front back side rear le'f ri
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B. Pumping ecord
1 Cute of flurnping - 2 Quantity Pumped.
Gallons
3. Gornponent. Ej Cesspool(s) Septic, `rank Tight[_� Tic Tank 1 ,g Grease Trap
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I—� Other (describe)
4. Effluent Tee Filter presenl? es If yes, was It cleaned? [� Yes (_� tlo
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5. Observed condition of componenl f)un') zed
6. ysterrt flt-trnped By
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I i51orrn4.doc. 11112 System Purnping Record Page 1 of'I
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