HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 757 TURNPIKE STREET 3/21/2022 RECEIVE['
MAR 21 Z0zz
Commonwealth of Massachusetts OjITH P\NDOVER
City/Town of North Andover TONEOTHDEgP'RTMENT
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:
757 Turnpike Street
Address
North Andover MA 01845
Citylrown State Zip Code
2. System Owner:
C&W Services/Stop & Shop
Name
140 Kendrick Street, Building C West, Suite 201
Address(if different from location)
Needham Heights MA 02494
City/Town State Zip Code
5714342034 x
Telephone Number
B. Pumping Record
1. Date of Pumping 12/03/2021 2. Quantity Pumped: 8000.0000
Date Gallons
3. Component: cesspool(s) FX� Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 0 No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
Normal water 1 4in bottaw sluclge 4in to solids Inlet hafflas are intact
Main line eiear. No ftitei ts present oil the tank; cuzzent tank can be outfitted
with a filter. Cover(s) secured. No 3rd party paperwork i e . Water level norma
mainline clear no filter present baffles intact light sludge and solids pumped 5000
gallons of grease.
6. System Pumped By:
Geoffrey Howard
Name Vehicle License Number
Wind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 01749
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/03/2021
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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