HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 100 TURNPIKE STREET 3/21/2022 �ECE'v�1'
Commonwealth of Massachusetts
City/Town of North Andover MAR 21202
a System Pumping Record JH ANp°jEa
Form 4 tOWN OF NOEPPA miE 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informatj�" e
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:
180.1_ Turnpike St
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Direct Supply
Name
6767 North Industrial Road,
Address(if different from location)
Milwaukee WI 53223
City/Town State Zip Code
8882257729 x
Telephone Number
B. Pumping Record
1. Date of Pumping 01/13/2022 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑X Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑Yes ❑X No If yes, was it cleaned? 11YesEj No
5. Observed condition of component pumped:
Normal water level- ti; I)ottom sludge air, top—solids Soth baffles are intact
maill lille eledr. No filtrar is 'Urrasent un the tank; curzent tank i5 not designed to---
e used with a filter. over s secured. No 3rd party paperwork i e . 1000
gallons pumped , send report to customer he hasn't been getting them he came out
personally asked for reports To be sent from here on out.
6. System Pumped By:
Jason Tedesco
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
01/13/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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