HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 165 BOSTON STREET 5/27/2025 1� Commonwealth of Massachusetts
/�' r� RJ North Andover
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������u� Pumping
Record
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Form 4
OEP has provided this 8omn for use by kzoa| Boards of Health. Other forms may be used, but the
information must be substantially the eumm as that provided here. Before using this form, check with your
local Board of Health\m determine the form they use.The System Pumping Record must be submitted to
the |noa| Board of Health or other approving authority within 14 days from the pumping date in
accordance with 318CWiR 15.351.
A~ Facility Information
Important:When
filling out forms 1. System Location:
cm the computer,
use only the tab 185 Boston Stn*et
key m move your Address
cursor-do not
North Andover MA 01845
use the mmm
key. City/Townstate Zip Code
2. System Owner:
^---� Eric Lyn oh
ame
ress(if different from location)
978-807-6348
B. Pumping Record
1. Date of Pumping 5%27/2025 2� Quantity Pumped: 1500
3. Type ofsystem: Cesspool(s) Septic Tank Tight Tank Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes N No
5. Condition of System:
Good, system operating
G. System Pumped By:
Jason Elliott S71437 or V85257
-Na-me Vehicle License Number
|vesterand Elliott Services LLC-OBAJaemn
Elliott Pumping
7. Location where contents were disposed:
GLSD