HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1468 SALEM STREET 12/14/2020 R
Commonwealth of Massachusetts FCC/v
City/Town of ro AFC I q ��
,W y North Andover
System Pumping Record y NOFNo 2020
Form 4 ��ryo Rryq
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DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informationp
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substantially the same as that provided here. Before using this form,check with your local Board of Health to dete me 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:
1468 Salem Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Steven and Naomi Najarian _
Name
1468 Salem Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9783147874 xNaomi
Telephone Number
B. Pumping Record
1. Date of Pumping 11/20/2020 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) FK-]Septic Tank ❑ Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes FK-] No If yes, was it cleaned? FYes No
5. Observed condition of component pumped:
System Operating Fine Nnrmal Water level. Tight top--1.J AQ M�Sderate battnm
i
t
current tank is not designed to be used with a filter. Cover(s) secured.
Recommended Boost additive,CCLS additive.
6. System Pumped By:
Michael Graham
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
11/20/2020
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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