HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 27 EAST PASTURE CIRCLE 2/20/2025 Town �������
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System Pumping Record
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DepartMent
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 hare. Before using this form, check with your
local Board nf 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 dote in
accordance with 31OCyWR15.351.
A, Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 27 East Pasture Circle
key m move your Address
m:mr-do not
North Andover MA 01845
use the return
key. ~'^'''~-' State Zip Code
2. System Owner:
�—� Mark Vera
Name
508-776-3820
B. Pumping Record
02/20/2025 1500
1. Date ofPumping 2. Quantity Pumped: Gallons
1 Type ofsystem: F-1 Cesspool(s) Septic Tank R Tight Tank El Grease Trap
[] Other(describe):
4. Effluent Tee Filter present? Yea Z No |f yes, was itcleaned? Yes No
5. Condition of System:
Good, b* Uproperly
G. System Pumped By:
Jason Elliott S71437 or V85257
Name Vehicle License Number
|vwster and Elliott Services LLC-DBAJason
Elliott Pumping
7. Location where contents were disposed:
GLSD