HomeMy WebLinkAboutSeptic Pumping Slip - 366 CANDLESTICK ROAD 2/2/2016 FORM a - SYSTEM PUWNG RECORD
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commonwealth of Massachusetts t
Massachusetts A00 --9 x"011
Systerrl l'zcmLrn� Rec rc TOWN OF FORT H ANDOVER
HEALTHD
weer
ystem ocanon
�yste n �' � � �
MKI
T:�,po: Emergency ❑ Routine �
❑ tic Tanl,: No ED Yes
Cesspc ol: No E] yes Sc P
Date ' Pumpine:
_ i �� Quantiry Pumped: gallons
IB®RACZ EK, S. ',
S\•stei: Permit
: Pumped by (Company): .-
Conte .ts transferred to:
Cont. .its disposed at:
Date Pumper Sienarure 6,,d*
Condition of systemlother comments:
DE9 A.PPAOVED FORM• 1./07/9S
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F NORTH-ANDOVER . �
SYSTEM PIlkPING C
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�1' 'TEM UWNR 8c At�DRESS SYSTEM LOCATION
(Ml!nple: left front of house) .
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OR
DATE OF PUMPING. QUANTITY PUMPrm LLON,
ND YES` SEPTIC TANK: NO YES vi
NATURE OF SERVICE; ROUTINE EMERGENCY
()IIaERVAT10NSr
GOOD C0Nlll7'10M _ FULL TO COVEk
HRAYY GREASE -BAFFLES IN PLACE
ROOTS ;; LEACH FIELD ItUNBAC& M
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER PRHF.R (EXPLAJN)
'O'STEM PUMPED i3Y: •�•
c.'U.N.,llvI I;NTS:
t
ON-1-1"-wrs TIZAPISP01ME0 T0: