HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 141 REA STREET 4/19/2022 RECENEG
Commonwealth of Massachusetts
-- APR 19 2022
City/Town of North Andover
a System Pumping Record
OF NORTH AN)OVEF
Form 4 TOHEEALTti DEPAR'fOENT
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:
141 Rea Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
William Perry
Name
141 Rea Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786856276 xHome
Telephone Number
B. Pumping Record
1. Date of Pumping 03/15/2022 2. Quantity Pumped: 1000.0000 _
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:
S�,stem Operating Fine Nnrmal- watal: level Light top solids Mndcrate bottom
studge. Buth bafftes aze intact. Main lillfe CtedL. No fitter is present on the tanki
current tank is not designed to be used with a filter. Cover s secured.
Recommended Boost additive,CCLS additive.
6. System Pumped By:
Michael Graham
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
03/15/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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