HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 208 BOSTON STREET 9/4/2025 ^=vr'/ vi 'WrInAndoVer
Commonwealth of Massachusetts OCT _ � y��
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��' �� North Andover
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System Pumping�� Record v� Health ��e���r�mm�����
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'OEP has provided this form for use bv local Boards of Health. Other forms may bm used, but the
information must be substantially the same as that provided here. Before using this k)nn, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the |Vom| Board of Health or other approving authority within 14 days from the pumping deb* in
accordance with 31OC|[WF< 15.351.
A~ Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 2O8 Boston Street
key mmove your Address
cursor-do not
North Andover �W/\ 01845-8308
use the mmm
City/Town~'v''~~ State Zip Code
2. System Owner:
^---~ John Kay
ity/Town State Zip Code
878-686-3528
B. Pumping Record
1. Date ofPumping 9/4/2025 2� C\uantiiyPurnp�d� 1500
Gallons
3. Type ofsystem: Cesspool(s) Septic Tank n Tight Tank El Grease Trap
El Other(describe):
4. Effluent Tee Filter present? X Yes F] No |f yes, was iLcleaned? X Yes Fl No
5. Condition of System:
Good, system operating properly
S. System Pumped By:
Jason Elliott S71437 or V85257
|ven|er and Elliott Services LLC-OBAJason
Elliott Pumping
7. Location where contents were disposed:
(5LSD