HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 285 CANDLESTICK ROAD 5/17/2026 Wn of Nofth Andover
Con,irnonweaM-'I of Mass,�chusetts
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(� C i f y/.T o w r-I c f -- - MAY 15 2026
System Purn nc Record
Health rtMen
DEP has provided this forn'7 for use by local Boards of Health. Other farms may be use , but the
inforrnahon rnust be subslanha lly H,)e Same as (hint provided h.erce. Before using this fo(m, check wiih
local Board of Health to determine the form They use. The Sys(ern Purnping Record must be subrn!M
(he, Ioc<:'3I Bo<.i(d of Health c)r other r.3pprovmg au(hon(y within 14 days fronn 'hey purnpint.) date;in
a,c C o r d a n c c with 3 1 0 C;M R 1 5.3,51.
HOUSE: r t back side real
,a FaCllify InformatIOl'I BUILDING: mr7C >clk side rear Ire
Important;Whon
DECK: under
(1111ng off(lorms 1 Sy slcn) I_(7C a(ioi1
r�f,r,10�com�nslef y��`"�''�/� tA'
y lab _ s �v )Le [__`._.�Gr
key to move,your A00ress
("Also, dooW
Mn
key, C,;lly/rows Stale Up Cade
J'� L Sy 71 61 (, wr G'r
r ,
Addross (II dtffe(onl from locallcn)
MA
Gltyrtr.,wn to p Cade
xk
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. eIaR.n,; i4"mbar
B. Pr_lrnpirig Record
1- Dwe of Purnplr7g 2. Quantity r'urnp�cS __._.._
)ale t allons
3. C0rnp0f)ent. (_� cesspool(s) Septic.Tank -Fight Tank Grease rr-,3
(� Other (describe), ------ _....._..
4. E((luent I eo 1=filler lDresE;lnl? ( _f ye., Q- fro If O)s y , was it cle=;arted"? (--� Yes [,] tJo
S. Ot)sc;('ved Condl(io rl elf Ou(7-!peel:
6 tiystern I't,irnpc d E3y
D4 e, ( ine�y M<rs 1F,f J`7F Miss 1RC1311_
PJ T.nrf' Vr,h cle Llcense NurYfq e r
E3 les (_nIe p(Ises, Inc.
culitp,my
t l cation where cc)n(crrls we re c)ispc seci
yntrlrut; C>( 1 I�lale r _ _..
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Sign lure of Rec ntr,�tvl F£a rrU cillly (or ,ich (zrudtt rr,cei -
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Syslem Purnpinq ReC;Grd r'aye