HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 743 FOREST STREET 7/7/2025 /�(]rn[�onyyea|fh of Massachusetts ��North
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Pumping
Record
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DEP has provided this form for use by local Boards of Health. Other forms
'
information must be substantially the same uo that provided here. Before using tN�f�3. �
local Board of Health Lo determine the form they use. The System Pumping Record must benubmi��d��"�
the |ooe| Board of Health mr other approving authority within 14 days from the pumping dote in
accordance with 318C[NR15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
cm the computer,
743Fonea� Btraet
uoeonh�e�b
keym move your Address
cursor-do not
North Andover MA 01845
use the return
xov. City/Town state Zip Code
2. System Owner:
^---� John |onnorone
Name
Address(if different from location)-
978-681-8146978-204-5707
Tel ephone-Number
B. Pumping Record
7/7/2025 1500
1� Date of Pumping �� Quantity Pumped:
Gallons-
3. Type ufsystem: F-1 Cesspool(s) Z Septic Tank n Tight Tank [l Grease Trap
El Other(describe):
4. Effluent Tee Filter present? Yea Z No |f yes, was itcleaned? Yes Z No
5. Condition of System:
Good, system dproperly
8. System Pumped By:
Jason Elliott Name -�71437orV852�7
|voeter and Elliott Services LLC-OBAJason
Elliott Pumping
y. Location where contents were disposed:
GLSD