HomeMy WebLinkAbout- Septic Pumping Slip - 80 BRIDGES LANE 10/9/2018 M���A����
Commonwealth Massachusetts
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r~' of North Andover
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S����t4�00 Pumping Record- — HEALO�DERART�ENT
Form 4
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 310C[NR15.351
A, Facility Information
Important:When
filling Out forms I. System Location:
on the computer,
use only the tab 80 Bridges Lane
key to move your Address
um«o -mu»m North Andover IVIA 01845-2225
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City/Town State Zip Code
2. System Owner:
�--" Patrice Louis
Name
617'803-8554
Telephone Number
B. Pumping Record
9h3/2018 1508
1. Date ofPumping 2. Quantity Pumped. Gallons
3. Type ofsystem: F7 Cesspool(s) Z Septic Tank F-1 Tight Tank [l Grease Trap
[] Other(describe):
4. Effluent Tee Filter present? Yes No |f yes, was itcleaned? Yes Z No
5. Condition of System:
Good, system operatingproperly
8. SyubsmPumpodBy:
Jason Elliott S71437
Name Vehicle License Number
|vaotor and Elliott Services LLC-D8AJason
Elliott Pumping
7. Location where contents were disposed:
GLSD