HomeMy WebLinkAbout- Septic Pumping Slip - 146 FARNUM STREET 10/9/2018 �IN�!��
Commonwealth of Massachusetts
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System �� Record
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Form 4
DEP has provided this form for use by local Boards of Health. Other forms may be used, butthe
information must be substantially the same as that provided here. Before using this form, check with your
|orm| Board of Health to determine the form they use. The 8yn&am 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 31UC[NR15.351.
A~ Facility Information
Important:When
filling outmnn I. System Location:
on the Computer, 148Fmmum �m�
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key to move your xo*p,nu
cursor do not
North Andover MA 01845 �
Use the return
key. City/Town State Zip Code �
2. SyetemOvvnec
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Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
9/5/2018 1500
1. Date ufPumping 2. C\uandtyPumpod:
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3. Type ofsystem: �� Cesspool(s) �/�� Septic Tank �[�~ Tight Tank ^�l
~ Grease Trap
E] Other(describe):
4. Effluent Tee Filter present? Yes Bd No |f yes, was itcleaned? Yes No
5. Condition of System:
Good system mtiproperly
0. System Pumped By:
Jason Elliott 871437
Name Vet Number
|veater and Elliott Services LLC-DBAJason
Elliott Pumping
7. Location where contents were disposed:
GLSD