HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 980 FOREST STREET 3/21/2022 ECEIVF
IL
Commonwealth of Massachusetts
City/Town of North Andover MAR 212022
System Pumping Record NowN OF NORTH
Form 4 H ART
HEALTH DEPMENT
M 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:
980 Forest Street,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Charles Apperson
Name
980 Forest Street,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7577144040 x
Telephone Number
B. Pumping Record
1. Date of Pumping 02/09/2022 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 No If yes, was it cleaned? �Yes No
5. Observed condition of component pumped:
System of operating Fine High ate la of mncjorate top selids Moderate bottom
5ludge. Both baffles axe intact. Maill IiLle eleclL. FtttUl is PlUbeLlt and has been
cleaned as needed. Cover s secured. Removed gallons to get them out of trouble
till pump chamber can be located and serviced. 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
02/09/2022
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 MAR 21202Z
City/Town of North Andover
System Pumping Record NDOVER
TOH��THpEPAR MENT
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:
980 Forest Street,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Charles Apperson
Name
980 Forest Street,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7577144040 x
Telephone Number
B. Pumping Record
1. Date of Pumping 02/11/2022 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: ❑ Cesspool(s) FjW-j 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 net Operating Fine- T water Not Applicable top solids Not
tan ; current tank is not designed to be used with a filter. Cover s secured.
Pumped 1500 gallons. 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:
163 Western Ave, Gloucester, MA 01930
02/11/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1
tECEIVED
Commonwealth of Massachusetts
City/Town of North Andover MAR 212022
System Pumping Record TOWN OF NORTH ANDOVEF
Form 4 HEALTH DEPARTMENT
M 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:
980 Forest Street,
Address
North Andover MA 01845
City/Town State Zip Code _
2. System Owner:
Charles Apperson
Name
980 Forest Street,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7577144040 x
Telephone Number
B. Pumping Record
1. Date of Pumping 02/15/2022 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: ❑ Cesspool(s) FjV-j 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 of Operating Fine NGt Applicable water level Light top solids Moderate
buttOM sludge. Main line eieca. No filter is preseiit on the tanki current tank is---
not designed to be used with a filter. Cover s secured. Removed all gallons from
lift station. 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:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
02/15/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1