HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 49 CARLTON LANE 9/19/2025 Town—. w/ �VU/{�
Commonwealth of Massachusetts c�ff� Andover
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_� - Pumping�� Record
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Form x »0a/�&^ ��
"�»v Department
DEP has provided this form for use by |oms| Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the |uce| Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OCIVIR15.351.
A~ Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 48 Carlton Lane
key mmove you, Address
cursor-do not
North Andover MA 01845-5802
use the return
kay. City/Town State Zip Code
2. System Owner:
~----~ Joseph Ni | i
Name
City/Town State Zip Code
781-387-3�75
To I
B. Pumping
Record
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9/1S/2Q25 1500
1. Date ofPumping Dotn 2. Quantity Pumped: Gallons
3. Type mfsystem: Fl Cesspool(s) Septic Tank Fl Tight Tank Grease Trap
n Other(describe):
4. Effluent Tee Filter present? Yes No |f yes, was itcleaned? Yes No
5. Condition ofSystem:
Good, system tiproperly
8. System Pumped By:
Jason Elliott S71437 or V85257
Name vomc|e License Number
|waehmrand Elliott Services LLC-DBAJaeon
Elliott Pumping
7. Location where contents were disposed:
GLSD