HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1801 TURNPIKE STREET 7/26/2021 Commonwealth of Massachusetts RECElVED
W City/Town of North Andover ��L 26 2021
System Pumping Record o ANDOVER
Form 4 �DoTNDEP RTMENZ
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
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 1801 Turnpike St
key to move your Address
cursor-do not North Andover MA 01845
use the return - -- - — - - - — --
key. City/Town State Zip Code
2. System Owner:
Sutton Hill
- --
Name
etun
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
Telephone Number
B. Pumping Record
21 11.
1. Date of Pumping 3. 2. Quantity Pumped: 1000
-
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:
Normal water level. 2in bottom sludge. 1 in top solids. Both baffles are intact. Main line Clear. Cover(s)
secured. Pumped 1000gal. Top solids light, bottom sludge light. backwash once covers secure.
6. System Pumped By: � s—d
�
Ronald Dunn
Name Vehicle License Number
Wind River Environmental
Company
7. Location where contents were disposed:
WSG
3.11.21
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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