HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 87 FOSTER STREET 7/9/2025 ��
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System Pumping
Record
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Form 4
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`~ Health ��e�qm�M��w��
DEP has provided this form for use by local Boards ofHeohh. Other fomnemay baDse�.~on��n��
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 {omy| Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31UC[NR15.351.
A, Facility Information
Important:When
filling outfonns 1. System Location:
on the computer,
87Fomha Streetu�m����� un
key mmove your Address
cursor'do not
North Andover MA O184G
use mo�mm
koy. City/Town State Zip Code
2. System Owner:
^---~ William Phillips
ame
City/Town State ip Code
817-831-7583978-423-3865
Telephone Number ----
B. Pumping Record
1. Date of ofPumping 2. Quantity Pumped: 1500
3. Type ofsystem: Fl Cesspool(s) Z Septic Tank M Tight Tank Fl Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yee Z No !f yes, was i(cleaned? Yes Z No
5. Condition ofSystem:
Good, system tiproperly
6. System Pumped By:
Jason Elliott B71437orV85257
|vaehsr and Elliott Services LLC-DBAJason
EUiouPum |
7. Location where contents were disposed:
GLSD