HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 258 REA STREET 7/16/2026 Commonwealth of as' ', U etts Town Of Wh Andover
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System Pumping Record AUG
Foy a
DEE has provided this farrn for use by Ioa#i Boards of Health C r e ; e
information must be substantiaiiv the same as that provided mere. Before using Otis form; E6;-,4 your
Iocai Board of Health to detem.ins the forn<tey use. "die Systern Pump nq Record. must be submitted to
the iocai Board of Heath or other approving authority vv*.7t;n 14 days frcrn the pumping drye in
accordance With 310 0 M R 15.351.
A. Facility Information
IrrowtLft Men
fps out forms System 'Lo tion:
on the oomwter, r~
use onty the t
key to move your ndc".- s
cursor-do not
use the return "
ecey. cryi'rovrs Smis ZIP code
System C 1 F
IL A4,
?``l,ci`rte
,^.dress Of+".fti—ent-ram to wn)
C.".)47 wr Smote Zip cage
Te:eo=ane N,-,ruder
B. Pumping Record
o �urDs Nara f _.
Date
.:.e!6ans
. ar^ cnen*" `cam.SJOc?{S') S c-tc Tank i -Sgil:Tan;, 7 Grease Trap
Other(describe;:
4. Efluent Tee Filter�SreSrcnZ'7 ?� y9s DIES: 4va,„ i4 Ctc, ,?'ec? 7 ``(es ❑ No
5. Cdserrvsd Condition of car~
is-;=ai-maton is wc;s_bincim d�iid or? a' e i' is^" n n! of this rnated
cut<.;:i,:o. 'tct resper:sib±e be and the dais above.
Syseenn P raped
s1uS eVezar?"#t,? ;. Cf /4 SaC`JVc `S SeDtic
S�rvio�
7. Lccatcrn v✓i'le canes. to We.-S dispas4--6:
eJ 'rc.
or.i r SEE eJove,
Si,,�:7.m#arse cr."R��tv.ncr F" E?'ty Cor cf;�c,7 uC'E 3�'vOV�
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