HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 307 CAMPBELL ROAD 5/13/2025 Commonwealth
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System Pumping
Record
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Form 4
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 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 |moa| Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OCMR15.351.
A, Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 307 Campbell Road
key to move your Address
cursor-do not
North Andover ��� 01845
� m use the tu
key. City/Town State Zip Code
2. System Owner:
�---" Christopher McNulty
Address(if differentfro m'location)
781-801-2337
To|en�onemumua,
B. Pumping Record
1. Date of Pumping 5/13/2025 2. Quantity Pumped: 1500
Date
3. Type ofsystem: F-1 Cesspool(s) Z Septic Tank R Tight Tank [l Grease Trap
[1 Other(describe):
4. Effluent Tee Filter present? X Yea E] No }f yes,was itcleaned? X Yes Fl No
5. Condition ofSystem:
Good system Uproperly
6. System Pumped By:
Jason Elliott S71437mrV85257
-Name- vehicle License Number
|veeker and Elliott Services LLC-DBAJason
Elliott Purn ping
7. Location where contents were disposed:
GLSD