HomeMy WebLinkAboutseptic tank - Septic Pumping Slip - 285 CANDLESTICK ROAD 7/6/2022 RECEIVEn
Commonwealth of Massachusetts JUL 0 6 2022
City/Town of North Andover TOWN OF NORTH ANDOVER
System Pumping Record ALTH DEPARTMENT
Form 4
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:
285 Candlestick Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Patricia Kim
Name
285 Candlestick Road
Address(if different from location)
North Andover MA 01845
Cityrrown State Zip Code
9788520775
Telephone Number
B. Pumping Record
1. Date of Pumping 04/22/2022 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑W Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑Yes rj'01 No If yes,was it cleaned? Yes No
5. Observed condition of component pumped:
System OperatingFine Normal waterliazel. Moderatersolids Moderate bottom
sludge. Buth baffters ciza iiitact. Main line Clear. No ftltez is present an Lhe tanki
current tank is not designed to be used with a filter. Cover s secured. Tank is
inches down dig charge should apply next service. Septic is 1500 gal mono tank.
Recommended Boost additive,Installing a riser.
6. System Pumped By:
Ronald Soucie
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Ha/v)erHill Disposal Site: 40 s Porter St, Bradford, MA 01835
04/22/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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