HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 45 TUCKER FARM ROAD 5/20/2026 CaC�(ll�l`1tJC1weac t�,� o [\Aassachusetts Town o�
Northj� Andover
City/-1-o w FI 'of
_ Systef� Pufr-rpinj] Record Form 4 MAY 2202 6
Ul f' has Woviced Ibis form for use by local Boards of l-ieal 7. ttT r r� be used, but Hie
nformadon must be st- bsl�afihk,-lly the same as Kai provided here. Cie,>>f�re` t�4 ( , check with yo
kcal Bowd of Health to dole nAw We ferret Mey use. The System fr urnping Record rnr)st be subrnit'ted
Hie local Board of k-iealtfh or ritiner approving authority wiliaio 14 days frorra 1-te pumping date in
accordance with 3 10 C MR 1,5 351 _.._.-
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(If)/ flfOtIT1cl�ICaf1 SUILDING: truant back side rear left.
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1, Date of 4'urn :rirrg�
6 l [r3ic;- � 1 Cuanfity Pumped! GaIlc
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3. Comp �ne,n(. C.-.� Ceasspooi(s) SeptiC.'1<arak (� 'Fight Tank Grease Trap�_.�
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4. E Mt,aent Tee f;ilkr r yr eswo? (�� Yes [� Wa If Yes, was if deaned? ED Yes Nc,
d Obseive�cf CcJncai6on cif c',Uriiponenl pumped
6. Syslen-a Purnpgd By
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