HomeMy WebLinkAboutSeptic Pumping Slip - 302 Rea St - 11/13/2024 - Septic Pumping Slip - 302 REA STREET 11/13/2024 Commonwealth �� kA Massachusetts
"��[�[������/u / �/ m/�����/ /U�����
r�'��� r� North Andover
~��� ��� � � ove[
y/ / �^/ /� / u / ^� `:
��m��u� Pumping
Record
System v �K��U�� n�����n�
���� � �p
Form 4
DEP has provided this form for use by local Boards ofHealth. Other forms may be used, but the
information must ba substantially the same aa that provided here. Before using this form, check with your
local Board of Health todetermine the form they use. The System Pumping Record must be submitted ho
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OCyWR15.351.
A, Facility Information
Important:When
filling Out forms 1. System Location:
on the computer,
use only the tab 302Rea Street
keym move your *uunoox
ovrsn, do not
North Andover MA 01845-4821
use the return�*y� ~`,''~'~' `~~ ~p~~~~
2. System Owner
~---~ Elizabeth Gill
AMdress(if 6-iffer-ent from location)
978-975'1622
B. Pumping Record
11/13/2O24 15OO
1. Oa�' ofPumping 2� QuantityPump�d�
Gallons
1 Type of system: [] Cesspool(s) 0 Septic Tank Fl Tight Tank n Grease Trap
Fl Other(describe):
4. Effluent Tee Filter present? Yes No |f yes, was itcleaned? Yes E No
5. Condition VfSystem:
Good, system o ti |
G. System Pumped By:
Jason Elliott S71437 or V85257
|veater and Elliott Services LLC-DBAJason
Elliott Pumping
7 Location where contents were disposed:
GLSD
11/13/2024
%Sure of HW6f6'r Date
ignature of Receiving Facility Date
/am,m*.uon'o3/no System Pumping Record^Page 1ofe