HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 287 FOREST STREET 5/20/2026 C orrm-io vvealt�-i of Massar hljsettsTown of
sr 0M Andover
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Y �� cRecord MAY 2 2 206
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C)EP has provided (his forrn 'of (.5(�( l)y local Boards of Health' vealth f- `i used, dttl (he
mo(mahon rnusf be subsI:anlially the sarne as (ha( prc)vlded h.erp. Before � 1 Menthsck with y(
local E: c) art:1 of Health (() II`fe fCrrrn lher y use The Sys(earn fa urnping Rec(ar(.9 roust be sw)nrme(i
the Iocr;'al Bo,,.,�rd of He al(h or other ,.1pprovir g au(h(_'>rily wi(hir) 1�1 days fron) the purnping date in
accordance vvittr 310 C;MR 1 r'a.3If>1 ---- -. _ ---- - -_.
�10USE1 Brant tack side rear left
A Facility Inforr-natloll EIUILOING frcnC ba(:k r,,idc rear left
Important,Whan DECK: undef'
fllling out (arms 1 Sys(ern L.oC a- (jo,,--
on the tarn, t t, f _
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use only(he IF3PI7 m °M XPI
key to move you TJ nss
Cwso, do rrol / q
use the retain _... __,...__,.._ .. _._..-
k ey ,lisle LII) Code
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f e>.lephonc Ntrrnba
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B PL-impir-1g Record
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1 Uate of 4_:,l.frlti.rirar�� 2 ..Ou",tr'ltlty pump d�
Gallons
3. COf'IIp00E,1rlt, (.__� cesspooa (s) .�_. ckatlr.Crank (� -fight "Fank
(_-1 G r(a s C r ra l:>
M 0(hef (describe): _ _ _
4, Effluent Tee Filter hrease3hii? ) Yes No If yes, was If cleaned? (� Yc.'s [�) tqo
Observed G'C7ndikiCin Of g;<>rra a(aractnl pumped:
I
6 Sys(em Furn4:ed By
tJ.avr l Ma<sr 1/a,Aa 5EC Mass I C)31L
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`rr'te' ;t7oGlr I ICe s
Baa esan En erprises., In(,
(.,Carnlrrtny
(.)c<;afion where; contcflo Vqe C1fr,17C) d.
C�LE�fJ
signaau)(o U( Fie ce lving F=IcJllty(err eau ach l adN ra u,;1-rt
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