HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 308 CAMPBELL ROAD 7/24/2026 Commonwealth of Massachusetts Town oil Nc;.,
........................ Andover
City/Town of NORTH ANDOVER
System Pumping Record -4 2026
AUG
Form 4
DEP has provided this form for use by local Boards of Health. Other K(nmll* P"� r
information must be substantially the same as that provided here. Before using tiffs ArmMwith 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 308 CAMPBELL RD —--------
key to move your Address
cursor-do not NORTH ANDOVER MA 01845
use the return 11- - —_-_--___--__- . ............ ........................
key. City/Town State Zip Code
loci 2. System Owner:
STEVE TESSLER
_Name- ------ -----_-----
ratrmn
Address(if different from— - location)
..........
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 7/24/26 2. Quantity Pumped: 10-00
Date allons
3. Component: ❑ Cesspool(s) Z Septic Tank F-1 Tight Tank F-1 Grease Trap
F-1 Other(describe): ---_----_- ....... ------
4. Effluent Tee Filter present? Fj Yes E] No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
------------
6. System Pumped By:
JAY CURRIER H79406
__----------- ------
me Vehicle License Number
J'S SEPTIC & DRAIN
Company
o-m p a I n I y
7. Location where contents were disposed:
I
GLSD
-------------- -----------_------------ .................—------- ------
7/24/26
.............- ...................
........------- .. .......I
Sign/ae of Hauler Date
ignature of Receiving Facility(or attach facility receipt) Date
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