HomeMy WebLinkAbout- Septic Pumping Slip - 466 SALEM STREET 11/13/2018 Commonwealth Massachusetts��ClM1O0��D\8/����/u / `�/ /vx��!�����<�/ /U!�~,~"� ~°ecr�����m
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System Pumping�� Record
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DEP has provided this form for use by|000| 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 |ooe| Board of Health or other approving authority within 14 days from the pumping deha in
accordance with 310CyNR15.351.
A, Facility Information
Important:When
filling out forms 1. System Location:
on the use memu� 480 Salem Street
key m move your Auumoa
cursor'do not
North Andover MA 01845-3110
use mommm
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State Zip Code
2. System Owner:
�----~ Mark McDevitt
781'366-5738
Telephone Number
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B. Pumping Record
10/10/2018 i6OO
1. Date ofPumping 1C\uaotityPumped.
3. Type ofsystem: F-1 Cesspool(s) M Septic Tank El Tight Tank Fl Grease Trap
[l Other(describe):
4. Effluent Tee Filter present? Yes Z No |f yes, was itcleaned? Yes 0 No
5. Condition of System:
Good, i |
O. System Pumped By:
Jason Elliott 871437
Name Vehicle License Number
|vastarand Elliott Services LLC-DB4Jaaon
Elliott Pumping_
7. Location where contents were disposed:
GLGD
10/10/2018
uler Date
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