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HomeMy WebLinkAboutSeptic Pumping Sliip - 24 Carlton Ln - 11/4/2024 - Septic Pumping Slip - 24 CARLTON LANE 11/4/2024 Commonwealth �� K8 Massachusetts ��C3������[)\8/�)��/u / ^�/ /v/����|�����/ /[J��~,`^, ��'fx/� r� North Andover "�� ��� �/ � � oVer ��' / /a / u / r` u System Pumping� Record Form DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the some 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 local Board of Health or other approving authority within 14 days from the pumping date in accordance with 31OC[WR15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab 24 Carlton Lane ------ key to move your xoueoo cursor do not NodhAndovar MA O1846'6GO3 use the return key. City/Town State— —'Code — 2. System Owner �—� Sarah Tower Name Address(if different from location) 6it—y,�fo—.n Zip Code 978-807-702 B. Pumping Record 1. Date of Pumping 11/4/2024 2� OuantityPumped� 1500 Date3. Type ofsystem: Cesapoo|(n) Septic Tank Tight Tank Fl Grease Trap R Other(describe): 4. Effluent Tee Filter present? Yes No |f yes, was itcleaned? Yes No 5. Condition ofSystem: Good, system o d | G. System Pumped By: Jason Elliott S71437orV85257 Name Vehicle License Number |weabar and Elliott Services LLC-DBAJason ElliottPumping 7. Location where contents were disposed: BLSO