HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 486 SHARPNERS POND ROAD 8/19/2025 �^�
Commonwealth of Massachusetts Town Of North
Andover
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SEP
System Pumping - -- - -- - 02025
Form 4
DEP has provided this form for use by local Boards ofHealth. Other e 4k Ue
information must be substantially the same aa that provided here. Before using this fonn.�*Uithyour
local 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 31UCIVIR15.351.
A. Facility Information
Important:When
filling outmnnn 1. System Location:
vn the computer,
use only the tab 486Sha P d � d
key m move your ^uure*n
cursor-do not
North Andover MA 01845
Use the�tum
key. City/Town ~a^e Zip Code
2. System Owner:
^---~ PnakaahJa ha
Name
Address(if different fir o-m location)-
978-223-5200
Telephone Number
B. Pumping Record
1. Date ofPumping 8K19/2025 2� Ouantih/ Pumped� 1500
3. Type ofsystem: Fl Cesspool(s) Z Septic Tank Fl Tight Tank F1 Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes Z No |f yes, was itcleaned? Yea Z No
5. Condition ofSystem:
Good, &e dproperly
6. System Pumped By:
Jason Elliott S71437 or V85257
ame Vehicle License Number
|vemtar and Elliott Services LLC-DBAJason
Elliott Pumping
7. Location where contents were disposed:
GLSD