HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 30 MILL ROAD 3/21/2022 „Vr Meo
Commonwealth of Massachusetts Mph 0
0
City/Town of North Andover NORjNa��N1 �nr+►vt)pVER
System Pumping Record SONEP�-�” .i14Delp
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:
30 Mill Road,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Alan Jordan
Name
30 Mill Road,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9783942070 x
Telephone Number
B. Pumping Record
1. Date of Pumping 02/14/2022 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: cesspool(s) ❑X Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes a No If yes, was it cleaned? ❑Yes No
5. Observed condition of component pumped:
System t Operating Fine High water level Light top salidsModerate bottom
tank; current tank is not designed to be used with a filter. over s secured.
Title 5 inspection 1500 gal high level inlet baffle in place, no outlet tee, outlet
lines going out in the side of the tank, tank is structurally sound, D box was
overloaded with 4 lines to a leaching field 77ftxl8ft system in hydraulic failure
c ncr� +;ran A..mc n+.mcr nccrl to ++.. r.ror7o l coral+;nr. F;cl A rc----c-- From+on n+,
6. System PumpedBy:
Gerardo Valentin
Name Vehicle License Number
Wind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 01749
Company
7. Location where contents were disposed:
02/14/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1
,aECENEL)
-------------
Commonwealth of Massachusetts MAR 21 all
City/Town of North Andover
System Pumping Record TOwNOF oEP fiMF
Form 4 HEALTH
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:
30 Mill Road,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Alan Jordan
Name
30 Mill Road,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9783942070 x
Telephone Number
B. Pumping Record
1. Date of Pumping 02/14/2022-_ 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) Fjy� 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 not operating Fine High water bdoda�ata top �Qlids M-derate �Ottnm
current tank is not designed to be used with a filter. over s secured. Pumped
1500gallons. Recommended No Recommendation.
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:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
02/14/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1
RECENED
Commonwealth of Massachusetts
City/Town of North Andover MAR 21202
a - System Pumping Record
Form 4 jOWNA►OF{NORPPS W41 R
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the h�mtat§R P 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:
30 Mill Road,
Address
North Andover MA 01845
Cityrrown State Zip Code
2. System Owner:
Alan Jordan
Name
30 Mill Road,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9783942070 x
Telephone Number
B. Pumping Record
1. Date of Pumping 12/23/2021 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) I—JW] 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:
S5,stem not Operating Eine High water leval- Light tLap SaiidS Tight; hott= sludge
Buth bafflas dze intact. Main Tine eied-r. No filter is yLe3ent: an the tank; current
tank is not designed to be used with a filter. Covers 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:
163 Western Ave, Gloucester, MA 01930
12/23/2021
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1