HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 857 CHESTNUT STREET 7/6/2022 RECEIVED
Commonwealth of Massachusetts JUL 0 6 2022
City/Town Of North Andover
VVN OF NORTH ANDOVER
Ti
= System Pumping 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:
857 Chestnut Street
Address
North Andover MA 01845
CitylTown State Zip Code
2. System Owner:
Steve Crabtree
Name
857 Chestnut Street,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6172858805 x
Telephone Number
B. Pumping Record
1. Date of Pumping Date 05/03/2022 2. Quantity Pumped. Gaallonsllons 000
3. Component: Cesspool(s) ❑X Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? N]Yes ❑ No If yes, was it cleaned? Q Yes ❑ No
5. Observed condition of component pumped:
System Operating r, r ester I-evel, Light top golids moderate bottom
sludge. Butli baffies ci-re ii1tact. Main line Clear. Filtez is present: and ims been
cleaned as needed. Cover(s) secured. Removed 1500 gallons. Recommend-a-Recommend-e-a Boost
additive,CCLS additive.
6. System Pumped By:
Robert Herrick
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
l_ 05/03/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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