HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 40 GRANVILLE LANE 3/20/2026 Commonwealth of Massachusetts TOWn of North Andover
City/Town of NORTH ANDOVER
System Pumping Record APR - 6 2026
Form 4
DEP has provided this form for use by local Boards of H+*aW pa(Mrd, but the
information must be substantially the same as that provided here. Bftefor rm, 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 CIVIR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 40 GRANDVILLE LANE ............
key to move your Address
cursor-do not NORTH ANDOVER MA 01845
use the return City/Town State Zip Code
key.
2. System Owner:
MATT FORRESTER
Name
Address(if different from location)—
City/Town State Zip Code
............--
Telephone Number
B. Pumping Record
1. Date of Pumping 3/20/26 ----------- 2. Quantity Pumped: 1500
Date Gallons
3. Component: F-1 Cesspool(s) E Septic Tank El Tight Tank F-1 Grease Trap
F-1 Other(describe):
4. Effluent Tee Filter present? El Yes 0 No If yes, was it cleaned? R Yes El 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 where co s were disposed:
GLSD ❑
3/20/26
..............
sTig-riatVer Date
-Signature-of—Receiving—Facility(or—attach facility—receipt)— —Date
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