HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 85 COLONIAL AVENUE 1/25/2021 �.. Commonwealth of Massachusetts Rscz/v 'o
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North Andover TGw AN ',S s?n?l
System Pumping Record y���/pORrHANppV
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:
85 Colonial Avenue
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Jeff Castaldo
Name
85 Colonial Avenue
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9785094846 xCell
Telephone Number
B. Pumping Record
1. Date of Pumping 12/30/2020 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: cesspool(s) FJVJ Septic Tank F1 Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes a No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
Systpm operating Fine Normal water level mnderate tnp solids mod
sludge. Batli baffles dre intaur— Main tine C
current tank is not designed to be used with a filter. Cover(s1 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
12/30/2020
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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