HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 740 FOREST STREET 4/5/2021 (3) Commonwealth of Massachusetts REC�1���
City/Town of North Andover
System Pumping Record NU��NPNoo
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:
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 03/23/2021 2. Quantity Pumped: 1800.0000
Date Gallons
3. Component: ❑ Cesspool(s) F.W-] Septic Tank Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes F.V—] No If yes, was it cleaned? 0Yes F1 No
5. Observed condition of component pumped:
System not operating Fine High water JL2"el Light top solids Light hottom sludge
current tank is not designed to be used with a filter. Cover(s) secured. Tech
pumped out 1800 gallon septic from tank high level failed t 5 new septic next few
weeks. Recommended Leaching Field.
6. System Pumped By:
Robert Hall
Name Vehicle License Number
Wind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 01749
Company
7. Location where contents were disposed:
163 Western Ave, Gloucester, MA 01930
03/23/2021
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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