HomeMy WebLinkAbout- Septic Pumping Slip - 25 ABBOTT STREET 10/9/2018 ���������
Commonwealth Massachusetts °~����� ���
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City/Town of North ADr!<]Ve[ A[ 0QYO1A
System Pumping
Record
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Form 4 HE�OHDERA����
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 datein
accordance with 31OCyWR15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer, 25&bboKStreet.uoauo��»e�u
key w move your Address
«"m»' do not North Andover MA 01845'4801
use the e$um
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2. System Owner:
�----~ Joseph Ni | i
Name
Address(if different from location)
CityTrown State Zip Code
781-387-3275
telephone Number
B. Pumping Record
8/13/2018 1500
1. Date of Pumping Date 2. Quantity Pumped:
3. Type of system: El Cesspool(s) N Septic Tank El Tight Tank F1 Grease Trap
O
Other(describe):
4. Effluent Tee Filter present? Yes No If yes,was it cleaned? Yes Z No
5. Condition ofSystem:
Good, system operating properly
8. System Pumped By
Jason Elliott S71437
Name Vehicle License Number
|vwstorand Elliott Services LLC-DBA Jason
Elliott Pumping
7. Location where contents were disposed:
GLSO
9/13/2018
S of Hauler Date
mmnn*.00c-0306 System Pumping Record~Puou I m14