HomeMy WebLinkAboutSeptic Pumping Slip - 8 Evergreen Dr - 11/15/2024 - Septic Pumping Slip - 8 EVERGREEN DRIVE 11/15/2024 Commonwealth �� h8 Massachusetts
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Record
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Form
OEP has provided this form for use by local Boards ofHealth. 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 ho
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OCK8R16.351.
A~ Facility Information
Important:When
filling out forms i. System Location:
nn the computer,
use only the tab .8-EvergrsenDive
key m move your Address
cursor-do not
North Andover MA 01845-6002
use the ogum
key. ~'^'''—'' State Zip Code
2. System Owner:
"---� Michael Kishi
ityrf own State Zip Code
078-683-2107808-227-3842
B~ Pump'ng Record
11/15/2024 1500
1. Date of Pumping oate 2. Quantity Pumped: Gallons
3. Type cfsystem: Cesspool(s) Septic Tank n Tight Tank Grease Trap
[] Other(describe):
4. Effluent Tee Filter present? Yea No If yes, was it cleaned? Yes No
5. Condition of System:
Good, operating
G. System Pumped By:
Jason Elliott S71437nrV85257
Name Vehicle License Number
|veshar and Elliott Services LLC-D8AJason
Elliott Pumping
7. Location where contents were disposed:
GLSO
11/15/2024
%S, ,,e—,—fH-a--u ................ D ate
�igiifme Date
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