HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 35 EVERGREEN DRIVE 11/10/2025 Commonwealth �� Massachusetts
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System Pumping Record
Form 4
OEP has provided this form for use by local Boards of Health. Other forms
information must be substantially the sarna as that provided here. Before using thi�YdMi��fiA
local Board of Health to determine the form they use. The System Pumping Record must be ouhni��rto
the |0t8| Board of Health 0r other approving authority within 14 days from the puqnpjOg date in
accordance with �1OCyWF� 15.35l. /»UK-1 0 ?02�
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A. Facility Information Health
Important:When ^ —^ trnen�
finin0out forms 1. System Location:
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on the computer,
use only the tab 35Eve Drive
key u`move your xugreea
cursor'do not
North Andover MA 01845
use the return ----------
k*y. `'^''~~'' ~'~`~ Zip Code
4:12. System Owner:
Sherri
Address(af-d-i—fferent from location)
978-376-6777781-572-4784
Telephone Number
B~ Pumping Record
1. Date ofPumping 10/7/2025 2� Quantity 1500
Gallons
3. Type ofsystem: Cesspool(s) Z Septic Tank Fl Tight Tank F] Grease Trap
R Other(describe):
4. Effluent Tee Filter present? Yes Z No |f yes, was itcleaned? Yes Z No
5. Condition ofSystem:
Good, system tiproperly
6. System Pumped By:
Jason Elliott S71437 or V85257
mame Vehicle License Number
|veab*r and Elliott Services LLC-DBAJason
BUottPumping
7. Location where contents were disposed:
GLSD