HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 325 BERRY STREET 5/19/2022 aEc��v�o
Commonwealth of Massachusetts 19101�
City/Town of North Andover
Et
System Pumping Record
Form 4 1OwN�AO�N��P P,
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the inforn it5n 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:
325 Berry Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Sean M. Dunn
Name
325 Berry Street,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9789793085 x
Telephone Number
B. Pumping Record
1. Date of Pumping 03/29/2022 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 ❑X No If yes, was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine Normal water level Heavy top solids bdadarate bottom
siudge. Buth bafftes aze intact. Main tine etadL. Nu ftitar ts present on the tanki
current tank is not designed to be used with a filter. Cover s secured. Pumped
1500gallons. Recommended No Recommendation.
6. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
03/29/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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