HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 45 INNIS STREET 8/18/2026 Commonwealth of Mass,achusetts Town of North Andover
CityfTown of I�X�Wer
System Pumping Record SEP 3 2026
Form 4
DEP has provided this form for usee by local Boards of Health. Oth 0-Irn M e used, but the
information must be substantially the same as that providsd here. nPOAMI%O(VAth your
local Board of H"th to determine the form they use. The System Pumping Record must be submitted to
the local Board of Heal h or other approving authority within 14 days from the pumping date in,
accordance with 310 OMR 15-351.
A. Facility Information
Importamt When
filling out forms I- System Location:
on the computer, 'i YN 34—
Use only the tab
key to move your Address
cursor-do not MA
use the return
key. CityiToym. State Zip code
System Owner.
Narne
Address Cr-f dfferentftm iocation)
City/Town state Zip code
Telephone Number
B. Pumping Record
Data of Pumping 2� Qjantity Puimpcvd: o n" ,
a-oat I I Gallons
3. Component: Cesspooi(4) :51Septic Tank 7 Tight Tank 71', Grease Trap
7, Other(describe):
4. Effluent Tee Filter present? F7 Yes 114 No i f Yes, was it cleaned? —7 Yes M No
5. Observed condition of cc mponent pumped:
All Of this estimated
i-'Iforrnation is non.-bindin above.
�q. Aid)pnly at the erne of pum�Dlng. Not responsibie eYond the date'
b
Name VehIcie License Number
J&S Development Corp. d/b/a Stewart's Sceptic
Service
7- Location where contents were disposed:
Sterwart's Giobal Environmental, LLC
20 §�a,4ffl St, a MAO1835
LN
See above
Data
See above
of Recelving Faojij+y(or attach 2c!P1y.rSC-.i -Z)
Date
t5ftrM4.doc•11/12
System Puping Record.page I of I