Loading...
HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 660 SHARPNERS POND ROAD 11/1/2021 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 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: 660 Sharpeners Pond Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Jaccfuie Kane Name 660 Sharpeners Pond Road, Address(if different from location) North Andover MA 01845 Cityrrown State Zip Code 9787647840 x Telephone Number B. Pumping Record 1. Date of Pumping 09/13/2021 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 © No If yes,was it cleaned? ❑Yes No 5. Observed condition of component pumped: S�,stem operating Pi na Normal water level Tight t p solids Licht hnt:t-nM Sludge Tiftet baffies ane intact. Main line tleaz. No fitttet iS pMSE211t U1, the tank, current tank is not designed to be used with a filter. over s secured. Remove 1500 gallons. Recommended Outlet Tee. 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 09/13/2021 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11112 System Pumping Record•Page 1 of 1