HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1175 TURNPIKE STREET 5/19/2026 Cornmonwealtf,� of Massa&hl..asetts Town of North Andover
City/Town of
System P --_ MAY 2 2 2026
um
ping Rec;orc_i
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Faith Department
D P has provided this form for use by local Boards of Health. Other forms may be used, bul th,e
Information must be substantially the snare as that provided herd. Before using this form, check with your
focal Board of Health to determine the forrn they near,. The System Pumping Record arrest br .submitted tr
the local Board of Health or other approving authority within 14 days from the purnping date In
accordance with 310 CMR 15.351
HOUSE: front back side rear left r�f;Irt
A. Facility Information B0It_DING: acI( side' �e � {t,*ror7t
Important: When DECK: under
(long out forms 1, Systern I._ocatlori:
on Hie cornputer,
us'e only the tab ^`
kr y(o move your A 1 ress
cursor-do nor N1A
usp the. return
CiI (sawn
Key. �laIe Zip Code
i 2. oystern Owner. /
r Name
------
Address (If difierc.nl (egret locate€7n) -
____ M A
CI y/Town — —._
Slade Zip Corte
Telephone hlui'rttaer
B. Pumping Record
1, Date of Pumping -. .__.. __.._____ 2. Quantity F7um p"ed.
C3<`ale y Gallons
3. Component: ( Ces6poogs) [ _ Septic -rank [ ] Tic r)t "rank
1 �.� Grease 1-r;art
[ ] Other (describe):
4, Effluent Tee filter present? Yr_/Ur
� No If yes, wets it cleaned? [_] Yes5. Observed conditio of cornponent ped:
6 System Pumped By:
DaveTlneY :ass I A�)S Mass 1AD31Z
Name _.__---
veriYrin L_it'.r,n,,r Nur her
Bateson Enterprises, Inc_
_-_...__-__-_._
f�ornpany
r t cation wtiere contents were c�isf�us tf:
G L
_ .--__ _ _-_.___
grin urt f Hauler Cate
Slgrralure; of Receiving Facility(or attach facilely receipt) (')atr3 _ — ---
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