HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 127 OLYMPIC LANE 5/16/2025 Commonwealth m� K8 Massachusetts
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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 local Board of Health nr other approving authority within 14 days from the pumping date in
accordance with 31OCINB15.351.
A, Facility Information
Important:When
filling out mnna 1. Byo0am Location:
on the computer,
use only the tab 127U| i Lane
key to move your Adue=e
cursor do not
North Andover MA O1845
use the n�um
key. City/Town State Zip Code
2. System Owner:
^---� AnthonyFesta
Nam e
978-738-9899978-609-6445
phone Number
B. Pumping Record
5/16/2O2� 1500
1� Date ofPumping 2Date � Quantity
1 Type of system: D Cesspool(s) Z Septic Tank Tight Tank Grease Trap
El Other(describe):
4. Effluent Tee Filter present? Yea Z No K yes, was itcleaned? Yes Z No
5. Condition of System:
Good system o bproperly
8. System Pumped By:
Jason Elliott S71437 or V85257
|waober and Elliott Services LLC'D8AJason
Ell iuttPum i ng
7. Location where contents were disposed:
BLSD