HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 35 SHANNON LANE 1/29/2025 ��� /� ����
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Pumping
Record FEB �� 2O��
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DEP has provided this form for use by local Boards ofHea|thv���Al& Wtffl
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 local Board of Health or other approving authority within 14 days from the pumping data in
accordance with 310CINR1G.3G1.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
3
use vn�mo�u 5 Shannon Lane
key oo move your ^mummo
cursor-do not
North Andover MA O1845
use men�um
xvv. City/Town s/oto Zip Code
2. System Owner:
`---~ Lucas Noble
Address(if different from location)
State zip Code-
978-394-1648
B. Pumping Record
01/20/2O25 1500
1. Oaha of Pumping oo� 2. Quantity Pumped: Gallons
3. Type ofsystem: n Cesspool(s) Septic Tank n Tight Tank [l Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes No |f yes,was itcleaned? Yea No
5. Condition ofSystem:
(� do 0e operating properly
6. System Pumped By:
Jason Elliott S71437orV85257
Name Vehicle License Number
|vester and Elliott Services LLC-DBAJason
Elliott Pumping
l Location where contents were disposed:
8LSD