HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 220 CANDLESTICK ROAD 4/30/2026 'A Town of NorthAndover
Commonweaiti,� of Mass' ichi,_.isetts
CityC1 own of -- ---- MAY 1,3 2026
System Pumping m
Y ping RecOrci
DepartmentHealth
DEP has provided this form for rase by local Boan:Js Of Health. Other forms may be used, but (Y�r
information must be substantially the ;.brie as f�rovided here. Before using This form, chPck< Nilh your
iccal Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other apprcnving tauihorify within I days from the pumping date In
accordance with 310 CMR 15,351
HOUSE: fr , t- acl< siCle rear rif;fil
A. Facility Information BU It.DING front back side rear left rif;r,i
Important: when DECK: under
(Illing out forms 1. Sy. L.ocaaI n'
on Ole cornputef
Use only I)ra Iat> l� 4�� �4----
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key. CilyfPowo Si 1e Zip Code
2. Sey' Prr' Owner
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Addross (If difierenl from location)
MA
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Telcphurac Nurnbpr
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B. Pumping Record
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'I, Date of PLimping C7,le � "� _ __.-._-- 2. l}caanCily Pc,rntpFci, y �-�l_.___.._
Mons
3. Component: [-71 Cesspool(s) ;.eptic Tans< -
L] -right TanSc Grease Trip
❑ ()ther (describe)
4. Effluent Tee filter present? Yes ;P<-) If yeas, wc,rs it cleaned? ��-� Yes (—] No
5. Observed condition of corrtponen( pu�lnpr d.
�/
5 stern Pumf)r d By:
ave 1-Ine r -
-----__ Y —Mass 1 -A9oE lass 1AD317
a rl1 E; A/e ttIde Licensc Ntimi) .r
akeso _:nferprises, Inc.
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7 oc 11U w rc e were di ;"Cij
( LSD
SI naluro of Hauler t C,
Signature of FZeceivinq FaciVi y (or all<srh (acili(y receipt) Utilr:
C5forrn4.doc, 11112 System Purnping Recorri Pape 1 0l 1