HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 740 FOREST STREET 4/5/2021 Commonwealth of Massachusetts
City/Town of North Andovertoe
System Pumping Record
Form 4 �o` �tNOEP
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:
740 Forest Street
Address
North Andover MA 01845
City/Town State _ Zip Code
2. System Owner:
Jane & Stuart Thompson
Name
740 Forest Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786827544
Telephone Number
B. Pumping Record
1. Date of Pumping 03/01/2021 2 Quantity Pumped: 1500.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑X Septic Tank ❑Tight Tank ❑ Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑ Yes 0 No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
System not Operating Fine High water- I c�vel - Light top solids Light bottom s1ludge
Both bafftes dLe inLact. Main line Ctear. No fitteL is pze5ent mi the tzinki 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
03/01/2021
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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