HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 146 RALEIGH TAVERN LANE 6/26/2026 Town of Norte Andover
Cor ,7monvvealt�-7 of M
h Y JUL an.
r City/Town of 2026
System Pumping Record
Department
DE P h<-a,�,i provided this furr'n for urge toy loc al Boards, of Health. Other fO('('T)s may used, bul the
nfort-nation rnust be substantially the, same ra-,l that p(ovide d here. Before using this forni, c;)c�Ck with your
Iragl Board of Health to deterr-nine the four They use `I-h Systern Pur-nping Record rnust be submitted 1ri
the local Buarol of or ott)ef rapprovinct 1u°,honty within I I cieys fron-i the pumping dntra'u�a
accordance witty 310 C IOR 15 ---..
L nUI)l- frrar'ri b)ac,.k rJck re,' r 1(It rif?1.it
A. Facility Information RtJIt_C)ING: front back side rr -ir Ic�(1 ri(;nr
Important:When DECK: ncler
lllling oW forrns 1. System) Locatiofv
on
ua,eIto rn 0 o yr i(r f\ cirr,s., � / .
yrs p
ip,
ll f C'.Y f1Iy 11ar3 t£1 fa �o 4."� _/.�.�.__. � ._4✓'�"d"✓�....,._. ..-... __.....,.,. ._._ .. .. . ......... -...,..._._ ._......
rW50( •do riol use the return --A-C l FTo 1A-1-C1k--C. SIaIe _ ...__._ _,._ {��
Key, n
1� , Systern Owner
�,rnr
-------- ,_ .._._
Addross, W cJifferonl (rorn location)
MA
_ ._.._...-.. -------.. _ —._
City/Town yld41+'f Zip Code
C"
leiephone Nurr'iber
P. Pumping Record
C7 ate of Pump Dirac <°p _ ',^ __ entity F'urrap,d - ...
C�alc C'ysYllorrs
3, Component: ..,� C;'estspool(s) __) Septic -Tank Ticlt�af Tank ['_] Crerase 1'rap
Other (describe)
G. Effluent Tee Filter pyreseot? O Y(R S ,] r,)o If yes, was it cleaned? Yes (\to
J. Observed condition of Cornpon nt purnpred.
6. System P(,tmped By:
Dave _i_Ine_y Mass 1AA95E- Mass IAD317
eateson EnferpriSes Inc, -
Company
7 1_0'. ion wtit re c ontcrnts wo(c dispci.;f:,d
z
Sigrrsll.ir off r lJrife --
c r7altirrg u(fdcr_eivinra 4-1C1(iCy or ail u.h facility rr•rt'Ir,,:)
11iforrn4Aoc- 1'1t12 `ayr,fem Purn(:)ing Racwrt