HomeMy WebLinkAboutSeptic Pumping Slip - 235 Farnum St - 10/25/24 - Septic Pumping Slip - 235 FARNUM STREET 10/25/2024 Commonwealth nfMassachusetts
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System Pumping Record
—
Form 4
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
i000| Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health nr other approving authority within 14 days from the pumping date in
accordance with 31OCIWR15.351.
A, Facility Information
Important:When
filling outmms 1. System Location:
on the computer,
use only the tab 235FarnumStreet
key to move your Address
cursor do not
North Andover MA O1O45-5GU7
use the mtum
key. ~'`,''`-'' ~^~^` Zip Code
2. System Owner:
~--� Mary Switzer
Name
Address(if different from location)
g78-O87-7322
B. Pumping Record
150O
1. Date ofPumping 10/25/2024 2� (2uontityPumpad�
Gaillms
�
3. Type of system: �Fl� Cesspool(s) ���� Septic Tank ^Fl� Tight Tank F Crumem Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yea No If yes, was it cleaned? Yea No
S. Condition ofSystem:
Goo11111d, iproperly
S. System Pumped By:
Jason Elliott S71437 orV85257
ame Vehicle License Number
|veatmr and Elliott Services LLC-OBAJason
Elliott Pumping
7. Location where contents were disposed:
8LSD