HomeMy WebLinkAbout- Septic Pumping Slip - 450 FOSTER STREET 10/9/2018 w &'/o
Commonwealth f Massachusetts��
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System-- Pumping�� Record
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Form
0EP has provided this form for use by local Boards ofHealth. 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 310CINR 15.351.
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A~ Facility Information
Important:When
filling out funna 1. System Location:
un the computer,
use only the tab 450 Foster Street
key m move your Amommo
ovmu,-do not
North Andover MA 01845
use the return
u«v. ~'^'''~^^ ~`~`~ Zip Code
2. System Owner:
�---` Thomas Lang
Name
Address(fi�—i—ff—ereiitfro6m-
City/Town State Zip Code
978-685-8379
B. Pumping Record
9/24/2018 1000
1� Date ofPumping 2Date � Quantity
Gallons
3. Type o[system: F1 Cesspool(s) [K Septic Tank [l Tight Tank El Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes Z No |f yes,was itcleaned? Yen No
5. Condition ofSystem:
Good, ba tiproperly
G. System Pumped By:
Jason Elliott S71437
Vehicle License Number
|vom\erond Elliott Services LLC-D8AJaeon
Elliott P i
7. Location where contents were disposed:
GL8D