HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 1770 SALEM STREET 10/20/2025 Commonwealth of Massachusetts Town of North Andover
City/Town of NORTH ANDOVER
System Pumping Record Form 4 OCT 2 o 2025
DEP has provided this form for use by local Boards of Health. OftmUm b d but the
information must be substantially the same as that provided her . -VWi%'Qh*k with your
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 310 CIVIR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 1770 SALEM ST —---------- -----------
key to move your Address
cursor-do not NORTH ANDOVER MA 01845
use the return key. CityfTown State Zip Code
2. System Owner:
KRISTEN WATSON
Name
renrn
-Address(if—different-from-location)- -------------------
State Zip Code
..............................
Telephone Number
B. Pumping Record
1. Date of Pumping 10/13/25 2. Quantity Pumped: 2000
Date Gallons
3. Component: ❑ Cesspool(s) Z Septic Tank ❑ Tight Tank F-1 Grease Trap
F-1 Other(describe): .............. ................
4. Effluent Tee Filter present? M Yes F-1 No If yes, was it cleaned? El Yes Fj No
5. Observed condition of component pumped:
GOOD CONDITION
----------
6. System Pumped By:
JAY CURRIER H79406
Name Vehicle License Number
J'S SEPTIC & DRAIN
..........
Company
7. Location whey ontents were disposed:
-GLSD
�74
10/13/25---
Sign—aty4of<14-a-We—r Date
Signature of Receiving Facility(or attach facility receipt) Date
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