HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 370 CANDLESTICK ROAD 9/7/2021 Commonwealth of Massachusetts
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 in �yust be
substantially the same as that provided here. Before using this form,check with your local W etermine the form
they use.The System Pumping Record must be submitted to the local Board of Health or o her approving authority within 14
days from the pumping date in accordance with 310 CM 15.351. n 7 ` ZA
A. Facility Information oFNORTHANoovER
1. System Location: TO Jij0EPARTMENT
370 Candlestick Road
Address
North Andover MA 01845
City/Town State Zia Code
2. System Owner:
Kenneth Delatorre
Name
370 Candlestick Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6177178634 xc
Telephone Number
B. Pumping Record
1. Date of Pumping 05/18/2021 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 FXj No If yes,was it cleaned? R YesFj No
5. Observed condition of component pumped:
±ntdut. .
tank is not designed to be used wit a i ter. Cover(s) secured. Pumped 1500gallons
Two and a half foot or solids. Recommended Boost additive,CCLS additive,Frequency
Increase.
6. System Pumped By:
Marcus Lark
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
05/18/2021
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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