HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 638 FOREST STREET 9/7/2021 Commonwealth of Massachusetts
n 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,� Eaust be
substantially the same as that provided here. Before using this form,check with your local Bt/�Rd of Health to determine the form
they use.The System Pumping Record must be submitted to the local Board of Health or other approving autlpprity within 14
days from the pumping date in accordance with 310 CMR 15.351. r
A. Facility Information TOWMOFNORIHANDUV
EK
1. System Location: H>:N-TH pEpARTMEW
638 Forest Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Steven and Stephanie Parkes
Name
638 Forest Street
Address(if different from location)
North Andover MA 01845
CitylTown State Zip Code
9787253381 xHome
Telephone Number
B. Pumping Record
1. Date of Pumping 05/18/2021 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) F.W] 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:
System Oper-4ng Fine Normal water level mndexate top solids moclerata bo—om
sludya. Both baffles ame intaut. Main line Clear. No filter is pieselit on tile tctLlkf
current tan is not designed to be used with a filter. Covers secured. Pumpe
1500gallons. Recommended Boost additive.
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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