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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 75 FOREST STREET 4/19/2022 gECE1VED Commonwealth of Massachusetts City/Town of North Andover ppR 192022 System Pumping Record OaT1AWoovEa Form 4 SOWN 0���.tN EPW-fjT ENT DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informpl�pAwlUst�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: 75 Forest Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Andrew Devore Name 75 Forest Street Address(if different from location) North Andover MA 01845 City/Town State Zip Code 6178940725 Telephone Number B. Pumping Record 1. Date of Pumping 11/16/2021 2. Quantity Pumped. 1500.0000 Date Gallons 3. Component: Cesspool(s) © Septic Tank Tight Tank ❑Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? Yes © No If yes, was it cleaned? ❑Yes ❑ No 5. Observed condition of component pumped: C si-em lino Minn Fine Normal a+cr lcvol Mnrio r3t2 i-np SGlidS Moderate Lnt-t-o I sludge. Both baffies ae intaut. Main lizie etedr. Na fit— p—mit an the tank; current tank is not designed to be used with a filter. Cover s secured. Pumped 1500gallons. Recommended Boost additive,CCLS additive. 6. System Pumped By: Marcus Lark 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 11/16/2 021 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1