HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 222 BRADFORD STREET 7/15/2025 ��������OUVy���|f�� m� K��]�����{��U��+�� ��
_ Commonwealth `~. Massachusetts~~^~~ /i/yk� mf�i~�.
��' ,�f North Andover
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Pumping
Record
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System ~ ~
���Form4 ""w�0�
70vc
�«�o
DEP has provided this form for use by local Boards nfHealth. Other�«� be used, but the
informabonmust beeubatanba||y the same aa that provided here. Bef h��4 heck with your
local Board VfHemhh (o determine the form they use. The System Pumping Rocorr����� Uedto
the local Board of Health or other approving authority within 14 days�omthe pumping date in '~
accordance with 31OC[WR15.351.
A. Facility Information
Important:When
filling out forms 1� System Location:
on the computer,
use only the tab
key to move your Address
cursor'do not
North Andover MA 01845-1108
use�e�mm
key. City/TownSta= Zip Code
1 SyatemOwner:
^---~ Kevin Kennedy
ame
Address(if-different from- 'loca-tion)
978-832-2605
Tdephone Number-
B. Pump^ng Record
7/16/2025 1508
1. Date ofPumping babe 2. Quantity Pumped. Ions
3. Type mfsystem: El Cesspool(s) Septic Tank [l Tight Tank El Grease Trap
L] Other(describe):
4. Effluent Tee Filter present? Yea No |f yes, was itcleaned? Yes N No
5. Condition ofSystem:
Good, a ha operating properly
G. System Pumped By:
JaaonB|io� S71437orV85257
|veater and Elliott Services LLC-DBAJason
Elliott Pumping
7. Location where contents were disposed:
LSLSD