HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 325 JOHNSON STREET 12/14/2020 Commonwealth of Massachusetts o CF/VF
City/Town of North Andover Too C 7
4�?
System Pumping Record ' F�oR ®�
i Form 4y�N�
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must bl-Q
substantially the same as that provided here. Before using this form,check with your local Board of Health to determine tht 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:
325 Johnson Street
Address
North Andover MA 01845
City/Town State _ Zip Code
2. System Owner:
Kevin Sparks
Name
325 Johnson Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786828736
Telephone Number
B. Pumping Record
1. Date of Pumping 11/24/2020 _ 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) FX� Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes Q No If yes, was it cleaned? Yes F No
5. Observed condition of component pumped:
System Operating Fine Normal water level T.Ight top sal 4.dq bdnci�rAt-e 1,)nt-tnjn
sludge. Botli baffles are intaut. Main ttne Clear. No filte.L is present an tlie tank;-
current tank is not designed to be used wit a filter. Covers secured. Pumped
1000 gallons. 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
t}"
11/24/2020
Sigrature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc• 11/12 System Pumping Record•Page 1 of 1