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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 271 CANDLESTICK ROAD 2/10/2022 RECEIVED If Commonwealth of Massachusetts City/Town of North Andover FEB 10 2022 System Pumping Record�/ p 9 TGtir.rnt OF NORTH ANDOVER Form 4 hiLALTH DEPARTMENT 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: 271 Candlestick Road Address North Andover MA 01845 Cityrrown State Zip Code 2. System Owner: Keith Laezza Name 271 Candlestick Road Address(if different from location) North Andover MA 01845 Cityrrown State Zip Code 9783975200 Telephone Number B. Pumping Record 1. Date of Pumping 10/06/2021 2. Quantity Pumped: 1000.0000 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: System Operating Ring Normal water level Moderate top gal-ids- Ddode,ate hottom siudge. Butin bafftes are intact. Mcr±n Iiiie etear. Nu fitter its present ail tile tank, current tan is not designed to be used with a fiiter. over s secured. Recommended Boost additive,CCLS additive. 6. System Pumped By: Michael Graham Name Vehicle License Number Wind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 01749 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835 10/06/2021 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1