HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 374 SHARPNERS POND ROAD 12/1/2025 I Town of Nofth Andm,
Commonwealth of Massachusetts DEC - 8 2025
City/Town of NORTH ANDOVER
System Pumping Record Health Department
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 CMR 15.351.
A. Facility Information
Important:When
filling out forms 1 System Location:
on the computer,
use only the tab key
SHARPNERS POND RD
__- ----------- -------
key to move your Address
cursor-do not NORTH ANDOVER MA 01845
usethe return ................................ ---------......................... . ................ —------------------
key. City/Town State Zip Code
2. System Owner:
JAMES FARO
............... —-------------. ............... ....................... -------------
Name
----------------- ............................................. .......................
Address(if different from location)
............. -—-------------------------------------------------- ................
City/Town State Zip Code
Telephone---Number
B. Pumping Record
1. Date of Pumping 12/1/25 2. Quantity Pumped: .1500
Date da'fio_ns
3. Component: El Cesspool(s) E Septic Tank F-1 Tight Tank F-1 Grease Trap
ElOther(describe): ....................................111-................................... ................................
4. Effluent Tee Filter present? E] Yes n No If yes, was it cleaned? R 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 w yt'4'e, ntents were disposed:
GLSD
........................
--------------------
12/1/25
----------- --------------................ .......-------- ........-------- ....................
Signature of Hauler Date
............................. .......................... ......................
Signature of Receiving Facility- (or attach facility receipt) Date
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