HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 168 GRAY STREET 8/14/2025 Commonwealth of Massachusetts
��' r� North Andover
��|T\� � �D�/�l ^^/ /=[�/ u / r�yl^^ovNer
Pumping
Record
������00 u ����DU��
System u- ��
Form
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must ba substantially the same as that provided here. Before using this form, check with your
|noa| 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 date in
accordance with 31OCyWRi5.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
mn the computer,
use only the tab 168 Gray Street-..-,-.--------
key to move your auurewm
cursor-do not
North Andover MA O1845-63O2
use the ne/um
--
key. ~'^r'~`~' State Zip Code
2. System Owner:
^---� EhkCoUod
own State Zip Code
978-984-5520
elephone Number
B. Pumping Record
1. Date ofPumping 8/1482025 2� OuontityPumped� 1500
Gallons
3. Type of system: Cesspool(s) Septic Tank n Tight Tank F-1 Grease Trap
El Other(describe):
4. Effluent Tee Filter present? X Yes n No If yes, was it cleaned? X Yes El No
5. Condition ofSystem:
Good, Uproperly
G. System Pumped By:
Jason Elliott G71437 orV862S7
|vestermnd Elliott Services LLC-DBA Jason
Elliott Pum i
7. Location where contents were disposed:
GLS D