HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1980 TURNPIKE STREET 1 3/21/2022 EECEIVEC:.
Commonwealth of Massachusetts
City/Town of North Andover MAR 212022
- System Pumping Record
Form 4 70NIN OFFt�1N{��FFR TVA E ppsNEW
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the infoMt1§fbe
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:
1980 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Affinity Realty Property Manaament
Name
63 Atlantic Avenue
Address(if different from location)
Boston _ MA 02110
City/Town State Zip Code
9786949399
Telephone Number
B. Pumping Record
1. Date of Pumping 02/07/2022 2. Quantity Pumped: 3500.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑X 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:
Na ai water le-el- 5i-n bottom Sludge lain top solids Both baffles are intact
Main itne etear. No fitter is pnesent on the tanki L;urxent tank is not designed to
e used with a filter. Cover(s) secured. No 3rd party paperwork i e .
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:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
02/07/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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