HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 99 OGUNQUIT ROAD 5/27/2025 Commonwealth m� Massachusetts
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System Pumping Record
_
Form 4
OEP 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 bz determine the form they use. The System Pumping Record must besubmitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31UC[WR15.351.
A, Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
key to move your Address
cursor'm«not North Andover MA1@45-147O
u�the mmm
xey, City/Town State Zip Code
2. System Owner:
~---~ |ve8Lafave
ame
878-23S-7744
To�ilB. Pumping Record
1. Date cfPumping 5C27/2025 2Ouantih/ Pumped� 1580
bateGallons
3. Type ofsystem: Cesspool(s) Septic Tank n Tight Tank E] Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes Z No |f yes,was itcleaned? Yee Z No
5. Condition of System:
Good system dproperly
6. System Pumped By:
Jason Elliott S71437urV85257
Name Vehicle License Number
|veeterand Elliott Services LLC-DBAJaaon
B|iott Pumping
7. Location where contents were disposed:
GLSD