HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 333 CANDLESTICK ROAD 4/9/2026 Cornn-Iot-wealth of Massachi.asetts ;
t �x, City/Town of NOrth Andover
System Pumping Record
Form 4 APR 13 2026
DEaP has provided this form for use by local Boards of Health. Other,far r r be, ,see but the
inforn-cation must be substantially the sarne as that provided here. Qefo e �,I „�i y yc>ur
local Board of Health to determine the form they use .1.h `wystrn-I Pumping Record must bey st d to
the local Board of Health or other approving authority w0in 11.1 days from the, purnping date in
accordance with 310 CMR, 15351
HOUSE: front fs a c k i d e rear <PP r r h t
A. Facility Information BUILDING: Front k s'k' sine mar left rlf;ht
Important: When DECK: Under
Hiding out forms 1. `.oyster') I ocatior
or)the cornpur er,
use only the tat?
key to move;yoor
cursor-do nr>V ( MA
use the return _.__ __,..- _..._ ___.__.
Cil fl'owr _
key Y SfatF. Ziff Code
i 2. `system Owner:
' V
— Name
/ K�U_
rer�r<
Address (if different from loca(ion)
MA
GiCy(Town Slate Zip Corte
Telephone Nurnb'er
B. Pumping Record
1 Date of Pumping - _. ____. 2. Quantity Pun')ped. —_-.. _.._.. ..
Ua1ri Gallons
3. Component: (_ ces6ipool(s) [ .eptic Tank (_] TI ht 1 ark
g [] Grease Trap
I_j Other (describe;): __.. --____ ____--
4. Effluent Tee Filter present? [_� Yes ° if yes, was it cleaned? ❑ YesfJc
5. Observed condition of cornponent pi_inped.
6, System PUrnped By:
7avo71r�ad" Mass 'IAAg5E Hass 1AD31Z
_. _. _...____ ___.__ _
cr nse hJumber
Bateson Enterprises, Inc.
7. Location where rr w re disposed
)ratE,
Signature of Receiving Facility (or attach facility roceipt) Date _..
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