HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 157 OLD CART WAY 7/6/2022 RECEIVED
Commonwealth of Massachusetts JUL 0 6 2022
City/Town Of North Andover
System Pumping N OF NORTH ANDOVER
Y P g Record HEALTH 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:
157 Old Cart Way,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
David Castillo
Name
157 Old Cart Way,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6176780451 x
Telephone Number
B. Pumping Record
1. Date of Pumping 04/15/2022 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 ❑ No If yes, was it cleaned? ❑X Yes No
5. Observed condition of component pumped:
System operati"g Fine Normal watal: IQ'Aal- p4nderate top Solids Moderate bottom,
bludge. Butli bafftes cire intaut. Main line Cledr. Filter j:5 preselit: drid i1cis been
cleaned as needed. Cover s secured. Recommended Boost additive,UUST-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
04/15/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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