HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 855 WINTER STREET 7/30/2025 ��C��DDlC��VV��3|f� nfK������3C�>�LJ��f�� Town of Commonwealth ^,. Massachusetts=^°= .-,..' "/ North Andover
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Pumping
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Form 4
DEP has provided this form for use by local Boards of Health. Other -N
information must be substantially the same as that provided here. Before using thisr 4ur
local Board of Health to determine the form they use. The System Pumping Record must bo submitted 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,
use only the tab 855VWnky Street
meym move your Address
cursor do not
North Andover MA 01845-1427
use the return
key. City/Town State Zip Code
2. System Owner:
^---� Kan+nK4awn
Name
ity/Town State Zip Code
978'387'8202078-771'0158
Telephone Number
B. Pumping Record
1. Date ofPumping 7/30/2025 2� Quantity Pumped: 1500
allons
3. Type ofsystem: [-1 Cesspool(s) Z Septic Tank F-1 Tight Tank [l Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? X Yes F] No |f yes, was itcleaned? X Yea E] No
5. Condition ofSystem:
Good system operating properly
8. System Pumped By:
JaaonB|iod S71437 or V85257
|vestorand Elliott Services LLC-DBAJaaon
-Elliott Pum i
7. Location where contents were disposed:
GLSD