HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 75 WINDKIST FARM ROAD 11/7/2025 Commonwealth
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System Pumping Record
—
Form 4
DEP has provided this form for use by local 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 local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CyWR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use��on��o�b
keymmove you, Address
cursor do not
North Andover MA 01845
use the return
key. City/Town` State— —' Code
2. System Owner:
~--A Christopher Angiolillo
City/Town State Zip Code
978-838-8845
Telephone Number
B. Pumping Record
1. Date of Pumping 11/7/2025 2. Quantity Pumped: 1500
Gallons
3. Type ofsystem: Fl Cesspool(s) Z Septic Tank Fl Tight Tank F-1 Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? Yea Z No |f yes, was itcleaned? Yoe ZNo
5. Condition of System:
Good system dproperly
G. System Pumped By:
Jason Elliott ��1437 orV8S257
Name Vehicle License Number
|voehar and Elliott Services LLC-OBAJason
Elliott Pumping
7. Location where contents were disposed:
GLSD