HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 526 WINTER STREET 7/7/2025 Town-'. w/ /��/T� �=�-
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System Pumping
Record
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' 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 or other approving authority within 14 days from the pumping dote in
accordance with 31OCIWR15.351.
A. Facility Information
Important:When
filling out forms 1, System Location:
on the computer, 52SV0nhs Streetu�un�d��h /
key to move your Address
cursor-do not
North Andover MA 01845
use the return
key. City/Town State Zip Code
2. System Owner:.---~ AkieonKincade
Name
Address(if different from location)
ouwTnwn State Zip Code
617-230-5912
T*|wpxonoNumber
B. Pumping Record
7/7�025 1500
1. Date ofPumping 2. Quantity Pumped:
3. Typo of system: F-1 Cesspool(s) Septic Tank n Tight Tank Grease Trap
[] Other(describe):
4. Effluent Tee Filter present? X Yea E] No |f yes, was hcleaned? X Yes [l No
5� Condition of System:
Good, operating
G. System Pumped By:
Jason Elliott S71437 orV86257
wame Vehicle License Number
|vesbar and Elliott Services LLC-DBAJason
Elliott Pumping
7. Location where contents were disposed:
GLSD