HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 597 FOSTER STREET 2/2/2026 Commonwealth of Massachusetts
Town Of NOrth AndOver
City/Town of NORTH ANDOVER
'10 System Pumping Record
�M ❑ Form 4 FE9 2026
DEP has provided this form for use by local Boards of Health. Oth orm may be used, but the
information must be substantially the same as that provided gig 63 rw n check with your
local Board of Health to determine the form they use. The System Pumping RRecopUg"mitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CM R 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 597 FOSTER ST - ------ .....................
key to move your Address
cursor-do not NORTH ANDOVER MA 01845
use the return --...................... ................................--—----------
key. City/Town State Zip Code
2. System Owner:
ANDREW FONZI
Name
enun
'Address(if"'-different-"from,--location)- —-------
-----------
City/Town .............................---------- -State-- Zip Code
------------- .........................- -------
elephone Number
B. Pumping Record
1. Date of Pumping 12/17/15 ---------- 2. Quantity Pumped: 1500
Date ----- Gallons n-'s -- -------
3. Component: E] Cesspool(s) Septic Tank f-1 Tight Tank F-1 Grease Trap
ElOther(describe): ----------— 111-----------1-1-11-11-.........................................
4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
............. -------- ... ---- ------
6. System Pumped By:
JAY CURRIER H79406
--------------- -------............... ------------- ------------------
ame Vehicle License Number
J'S
SEPTIC
S E P TIC.....& DRAIN
-& ----- - ----.. ... -- -----
Company ------
7. Location where contents were disposed:
GLS
............ --------- .......... ------------ ..................... ------ ..........
12/17/25
a4fdA.T
------------ —--------- ........
ature of Hauler Date
- --------- ------------------- .. .................. ......----..................................
Signature of Receiving Facility(or attach facility receipt) Date
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