HomeMy WebLinkAbout- Septic Pumping Slip - 166 DUNCAN DRIVE 10/9/2018 Commonwealth
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(�' of North Andover
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���*� Pumping �� r�
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Form HEALTKDEA�T���
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
|nk/nneiino must be substantially the same as that provided here. Before using this funn, check with your
|oms[ Board of Health to determine the form they use. The System Pumping Record must be submitted to
the |noe| Board of Health ur other approving authority within 14 days from the pumping date in
accordance with 31OCk8R15.351.
A. Facility Information
Important:When
filling out mnnx 1. System Location:
un the computer,
use only the tab 188 Duncan Drive
ueym move your xxomna
cursor'do not
North Andover MA 01845-2231
use the return
k*y, City/Town State Zip Code
l System Owner:
~---~ William Driscoll
Name
City/Town State Zip Gode
878-689-3 0
B, Pumping Record
9/5/2018 1500
1. Date of Pumping Date 2. Quantity Pumped:
�l
3. Type ofayutemn: �� Cesspool(s) ~[�~ Septic Tank �Fl� Tight Tank ��l
~ Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes No K yes,was dcleaned? Yes No
5. Condition ofSystem:
Good,
O. System Pumped By:
Jason Elliott S71437
Vehicle License Number
Ivester and Elliott Services LLC-DBAJason
Elliott Pumping
7. Location where contents were disposed:
8L8D