HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 51 BANNAN DRIVE 7/15/2025 Commonwealth nfMassachusetts Town rfNorth Andover
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System Pumping Record AUG 1 1 2O75
Form 4
OEP has provided this form for use bylocal Boards of Health, 0"pt"rttt the
'information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health tu determine the form they use. The System Pumping Record must be submitted k»
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OCyWR15.361.
A. Facility'
fillingrtant:When
� out forms i. System Location:
on the computer,
use only the tab 57 Bonnon Drive,,-
key mmove your /mnmn
cursor do not
North Andover MA O1845
use the�mm
key. City/Town^ State Zip Code
VQ 2. System Owner
Tyler Worden
i4a me
CityjTown State ip Code
781-953'6912
Telephone Number
B. Pumping Record
1. Date ofPumping 7/15/2025 2� DuanhtyPumped: 1500
DateGal[on s-
3. Type ofsystem: Ej Cesspool(s) Z Septic Tank Fl Tight Tank Ej Grease Trap
LJ Other(describe): -
4. Effluent Tee Filter present? Yea Z No |f yes, was itcleaned? Yes Z No
5. Condition of System:
Good system dproperly
G. System Pumped By:
Jason Elliott S71437 mrV86257
|mssterond Elliott 8mrvio*e LLC-DBAJoaon
Elliott Pumping
7. Location where contents were disposed:
GLSO