HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1171 TURNPIKE STREET 3/1/2025 Commonwealth of Massachusetts Town of NOrth Andover
--- - a City/Town of North Andover
System Pumping Record
� '� APR 10 2025
k. Form 4
DEP has provided this form for use by local Boards of Health r used, but the
information must be substantially the same as that provided here. Before u I r*eck 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 310 CMR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 1171 Turnpike Street
-- __...... .....................
key to move your Address
cursor-do not North Andover MA 01845
usethe return -- -- ----- —�_.._._.......... ...._......................__........_........- ------ ..__._._. ..............._..__........__---
key. City/Town State Zip Code
� 2. System Owner:
r�
Wolf Properties
Name —_—___.._..__...........____._.._.._.......--...-- ------
Address(if different from location)
City/Town State Zip Code
603-777-0362
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.__.._......_._..__............._...- --- -...__..__........._.........
Telephone Number
B. Pumping Record
3/1/2025 2000
1. Date of Pumping ..Date-----.........._.................---.._..----- 2. Quantity Pumped: --G--a-1 lons
-- -- ---------
3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe): — — �.__._...... --- -- -- --..._..._.....__.........
4. Effluent Tee Filter present? Yes ® No If yes, was it cleaned? Yes ® No
5. Condition of System:
Tank and pump chamber Good, system operating properly
6. System Pumped By:
Jason Elliott S71437 or V85257
--- - ......._.. _._._.... __--........ -.._...-- ----._..__..........__.... -- -- - -...__................................._.........._...._............
Name Vehicle License Number
Ivester and Elliott Services LLC-DBA Jason
Elliott Pumping ......___..._.........
7. Location where contents were disposed:
GLSD
3/1/2025
Si ure of Hauler Date
Signature of Receiving Facility Date
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