HomeMy WebLinkAboutseptic tank - Septic Pumping Slip - 151 OLYMPIC LANE 2/23/2021 (3) Commonwealth of Massachusetts RECEIVED
City/Town of North Andover FEB 2 3 2021
System Pumping Record A, Form 4 e $ T�.,�
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:
151 Olympic Lane
Address
North Andover MA 01845
City/Town State ZiQ.Code
2. System Owner:
Rolfe Trevisan
Name
151 Olympic Lane
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786818934
Telephone Number
B. Pumping Record
1. Date of Pumping 01/14/2021 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 ❑X No If yes, was it cleaned? 11 Yes ❑ No
5. Observed condition of component pumped:
High water el Light top solids Light bottom sludge Both ha€flex are intactMain lizie etetr. Na fitter is pLesent oil the tdriki uunelit tank is not de-signed to
e used with a filter. Cover s secured. Repairs needeaFTHi-g—H-liquid levelin tank.
Pumped tank. Flush test flowing. Dug up outlet cover. Found line from outlet to D
box not working need to dig it up and chase back to fix probable break.
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
.� 01/14/2021
ignature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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