HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 544 FOSTER STREET 9/7/2021 Commonwealth of Massachusetts
;y City/Town of North Andover
-� System Pumping Record
,+" 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 of IrtoWI %termine the form
they use.The System Pumping Record must be submitted to the local Board of Health or o pfti7Crfng authority within 14
days from the pumping date in accordance with 310 CMR 15.351. a
A. Facility Information
)ff e7
1. System Location: TpH��pF,114 0400ENT
544 Foster Street _
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Tung Pham
Name
544 Foster Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6175015125 xcell
Telephone Number
B. Pumping Record
1. Date of Pumping 05/17/2021 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) FXJ Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes ❑X No If yes,was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
sludge. Butli baffles are intact. Main iine Clear. No filteL is gresent on tim tank;
current tank is not designed to be used with a filter. Cover(s) secured. Removed
1500 gallons. Recommended No Recommendation.
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
05/17/2021
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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