HomeMy WebLinkAboutPumping Slip - Septic Pumping Slip - 1 PENNI LANE 12/17/2024 Commonwealth Massachusetts
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System Pumping Record
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 to
the |oou| Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OCPWRi5.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 1 Penni Lane
key m move your Address
cursor-do not
North Andover MA 01845-6208
use the return -------
xev. City/Town State Zip~~~~
2. System Owner:
�---^ Donie|Tuoci
Name
Uty/Town State - Zip Code
817-818-7603
B. Pumping Record
12/17�O24 1500
1. Date of Pumping 2. Quantity Pumped:
3. Type ofsystem: Fl Cesspool(s) M Septic Tank [1 Tight Tank n Grease Trap
[] Other(describe):
4. Effluent Tee Filter present? X Yes [l No |f yes, was i\cleaned? X Yes No
5. Condition of System:
-,-,,Good, iproperly
S. System Pumped By:
Jason Elliott S71437urV85257
ame Vehicle License Number
|vmstmr and Elliott Services LLC-DBAJason
Elliott Pum i
7. Location where contents were disposed:
GLSD