HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 76 EVERGREEN DRIVE 6/16/2026 Corrmwrryiw ��i lth of E�s schusE,tt
Town of North Andover
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G,r Tlty/Town o _.._.__. JUL 202
System c �Dinc� �, Acord
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-� Health Departmen
t�E:f7 has provided this focrn for usc,, by local Boards of V-iealth. Other fours may be used,�ul I,.
informahon must be subsR an(iaHy the srar-ne as (hak provided here. Before using this form, check with y
Iocal Board of Health to deteirninc the lown (hey use The Systern Pumping Record musi be submittec
the local Board Of P Iealth of r,.>Ct' of approving liWhonIy wi(hin 1 el days fror-n she pumping date ill
accordance with 310 C,MR 15 3,5"I .-----
HOUSE: fcom � l�
rac, lice rc�
A. Facility Infermatlofl 6UtLDIPrdG From back side rear ��1F.�f
Irn�r��lerrf;wI'�t`tn
Df-.C::K: Und(-If
Mllncg oul lorry), Sysien-) l_C capon p, -ere
u s C o r y 1 r o u,)b '` `C'.4/" f 4. e
on It)(,, com /014
lab ...._ � -._� - ----
Y o your A�fd"'ss -
curs(p do rrr,)I
key y lfr>Code
y. lC(l') t:7vvne�t
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Rdc3rras5 (It E;/i( c,ronrl from Icrr,aUr7n)
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c=lepl dr7e urn or
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B. Puir inc FReccrcl
_. 51. C)z)te v( f>1.rrmrrr>in 1 - ._. 2 (�uantit Pud
C,)S3lE;' Y me� '' CJ dIOnS
E 0 n e rr_�� you{(s) �zptic .I a rr4s
(w -right Tank C;,rraasc
4. Effluen( Tee Filter present? [_.� If Yes ,rc) es, was it clnaned?
- v CJ Y�� Cw) I\t
S Observed CCarlClitiC7n of r;r,>rnp')ne r)l Oun)pet
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C�av( l m y Mass "1AA95t fwss 1A[>3'Il
Va;tiir,lr t.lE,errsc nJtn'r)t) r
wieson EnIerpfis �s, inc
9t1('7ri wl5t6d CGQtr''rlf5 wee dIS1:)1> 'c'(I
Daie
oognalr�n; t;)( 1lauler _.
1�t,GeiVIO� F�u.ilil r of aU,n IE f willf n„cr;i t
t 1 ) t / 6 ) Ifa1r --- - -
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