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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 81 SAW MILL ROAD 7/26/2021 RECEIVED Commonwealth of Massachusetts ,JuL 2 6 202, City/Town of North Andover = TOWN OF NORTH ANDOVF System Pumping Record HEALTH DEPARTMENT 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: 81 Sawmill Road Address North Andover MA 01845 City/town State Zip Code 2. System Owner: Lisa Perella Name 81 Sawmill Road Address(if different from location) North Andover MA 01845 City/Town State Zip Code 9784018788 Telephone Number B. Pumping Record 1. Date of Pumping 06/05/2021 2. Quantity Pumped. 2500.0000 Date Gallons 3. Component: Cesspool(s) © Septic Tank F 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: S;zstara not Operating Fine. High tP,l euell T,'ght to solids Moderate hottom sludge. Butil baffies are intact. Maj:11 ti:11e ettz%,.L. Fttter is present and ilds been cleaned as needed. Cover s secured. Removed 2500 gallons. Recommended Pump Repairs. 6. System Pumped By: Robert Herrick 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 06/05/2021 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11112 System Pumping Record•Page 1 of 1