HomeMy WebLinkAboutSeptic Pumping Slip - 40 DUNCAN DRIVE 2/1/2016 i
Commonwealth ofMassachusetts
North Andover, Massachusetts
System Pumping Record
System Owner & Address:
Joyce McKew
402 Boxford Street
North Andover, Ma 01845
Location of system: Rear
Date of Pumping: October 11, 2011
Type of system: Septic Tank
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Gallons Pumped: 1000 gallons
System pumped by: RECEIVED
$
Service Pumping& Drain Co.,Inc.
(.�. 4.1
S Hallberg Park I OWN OF NORTH ANDOVEIFk
North Reading,Ma DEPARTMENT
License#: BHP-2011-0413,0412,0411,0410,0409,0408
Contents transferred to: Greater Lawrence Sanitary District
Date: October 11, 2011 Pumping Technician: MW
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This is PROPRIETARY and CONFIDENTIAL information that may
be used only by the Board of Health for regulatory purposes
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-' itffown O ORTH :ANDOVER MASS
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NOV 13 2006
Forni 4'
s p Y pp ldgl4 t� ord must
DEP,has provided this form for use b local Boards of Health. ter 4
be submitted to the local*Board of Health or other approving a � - •-A. Facility Information
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important:
When filling out 1. System Location:
forms on the
computer,use
only the tab key Address /
to move your R
cursor-do not City/Town State Zip Code
use the return .
key..,.. ,:.• ;
2,' System.Owner:
Name
Address(if different from location)
City/Town State 9Jy/y, --p .C/ode
• / 6
Telephone Number
. . B. Pumping Record
�,, �"� • 1. Date-of Pumping Dat " 2. Quantity Pumped: a uo
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Type of system: . ❑ Cesspool(s) eptic Tank ❑ Tight Tank
M ❑' Other(describe):
" 4. Effluent Tee Filter present? [I Yes �' . lo If yes, was it cleaned? ❑ Yes ❑ No
5. ` Condition of System:
Y '
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{
6. ASyern Pumped By:�
mm
Name Vehicle License Number
+ rdj fna.
Company
7. . Location where contents were disposed:
,Sl'gnatu a ofG, uler"° Date
http://Www.mass�ov/dep/water/approvals/t5forms,htm#inspect
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE ,�Q '
— 0_
SYSTEM OWNER&ADDRESS SYSTEM LOCATION
DATE OF PUMPING a" 0 _QUANTITY PUMPED
CESSPOOL NO YES
f SEPTIC TANK NO YES
NATURE OF SERVICE: ROUTINE „✓/ EMERGENCY
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OBSERVATIONS:
GOOD CONDITION V1 FULL TO COVER
HEAVY GREASE BAFFLES IN LACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER OTHER EXPLAIN
SYSTEM PUMPED BY + ,
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COMMENTS:
CONTENTS TRANSFERRED TO 2 '
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TOWN OF NORTH
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: � f QUANTITY PUMPED GALLONS
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CESSPOOL: NO YES SEPTIC TANK: NO YES
r�!�
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
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SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO:
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