Loading...
HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 274 BOSTON STREET 7/26/2021 RECEIVED Commonwealth of Massachusetts JUL 2 6 NZI City/Town of North Andover vER TOWN HEALTHDEPARTM System Pumping RecordEQN7 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: 274 Boston Street, Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Gary & Cheryl Fenton Name 274 Boston Street, Address(if different from location) North Andover MA 01845 City/Town State Zip Code 9785904768 x Telephone Number B. Pumping Record 1. Date of Pumping 06/21/2021 2. Quantity Pumped: 1500.0000 Date Gallons 3. Component: ❑ Cesspool(s) © Septic Tank ❑Tight Tank Grease Trap Other(describe): 4. Effluent Tee Filter present? Yes © No If yes,was it cleaned? ❑Yes ❑ No 5. Observed condition of component pumped: Six Operating Eine NQrM2i to of nn to top solids Moderate-1Dattom sludge. Both baffles are intact. tq�Ljjj J:jj, eju�,L. Nu ftiter is present: on the tank, current tank is not 3esigned to be used with a filter. over 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: HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835 06/21/2021 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1