HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 181 FARNUM STREET 6/3/2026 Commonwealth of Massachusetts Town of Nofth Andover
City/Townof North Andover
System Pumping Record JUN 9 - Z026
Form 4
DEP has provided this form for use by local Boards of Health. OthiefEAW nUPPUW)6flthe
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CIVIR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab Residential-181 Fannum St
......................................................... -----------......... ---------- ---------------
key to move your Address
cursor-do not North Andover MA 01845
usethe return ....... ---------------------------- .......------ ....... ..............
key. City/Town State Zip Code
2. System Owner:
Spencer Contracting Corp.
...........
Name
Address(if different from location)
........................... ................................. --------------------------------------- ........................................................
bit'�yl'own.............. State Zip Code
978-741-8000
Telephone Number
B. Pumping Record
6/3/26 1000
1. Date of Pumping Da.t..e------------- 2. Quantity Pumped:
3. Component: ❑ Cesspool(s) On Septic Tank n Tight Tank R Grease Trap
M Other(describe): .........................................................
4. Effluent Tee Filter present? n Yes ❑ No If yes, was it cleaned? [__j Yes ❑ No
5. Observed condition of component pumped:
good
........... ....................----------------------------------------- -------------
6. System Pumped By:
Dan Drake 5733A
__.......... ........................... ..........................
Name Vehicle License Number
-Service Pumping&Drain ..........
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District
-----------................. ................................ ............ ........................................................................... ..........
Lys
6/3/26
..........I-------
Signature of Hauler Date
.____................ ................................... ............ .................
Signature of Receiving Facility(or attach facility receipt) Date
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