HomeMy WebLinkAboutSeptic Pumping Slip - 45 WINDKIST FARM ROAD 5/7/2018 `
Commonwealth of Massachusetts `
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HEAL,,nHOEPAFTMENT
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be Submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310CMR 15.351.
'
A, Facility Information
Important:When
filling t forms 1. System Location:
on the computer,
use only the tab 45 VVindkist Farm Rood
keymmoveynvr pmureun
cursor-do not
NorthAndover [WA 01845
return
key. City/Town State Zip Code
l System Owner:
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Stephen Costa
Address�if different from location)
781-484-7203
Telephone Number
B. Pumping Record
4/27/2U18 1�0O
1. Date ufPumping 2. QumndtyPumped.
allons
3. Type ufsystem: Fl Cesspool(s) F1 Septic Tank Fl Tight Tank El Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yea No |fyes, was itcleaned? Yes No
5. Condition ofSystem:
Good, system operatingproperly
8� 8yaLamPumped By:
Jason Elliott S71437
..""= Vehicle License Number
Ivester and Elliott Services LLC-DBA Jason
Elliott Pumping
7. Location where contents were disposed:
GLSD