HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 315 BERRY STREET 12/14/2020 K'ecovF
Commonwealth of Massachusetts SEC
F City/Town of North Andover
System Pumping Record
.7 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
1. System Location:
315 Berry Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Michael Santangelo
Name
315 Berry Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7819537304
Telephone Number
B. Pumping Record
1. Date of Pumping 11/24/2020 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: ❑ Cesspool(s) FXJ Septic Tank ❑ Tight Tank ❑Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑Yes ❑X No If yes, was it cleaned? ❑ Yes No
5. Observed condition of component pumped:
Syst�M Qpprating Pjn� NnrMAI WAtpr 1 Pve 1 Moderate top solids Moderate bottom
sludge. Batli bafftes are intacC. Main line Ciectr. No fitter is pme'sent an the tank;-
current tank is not designe to be used with a filter. Cover(s) secured. Pumped
1500gallons. Recommended Boost additive.
6. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 01749
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
i"` 11/24/2020
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1
