HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 757 TURNPIKE STREET 7/6/2022 RECEIVED
Commonwealth of Massachusetts
City/Town of North Andover JUL 0 6 2022
System Pumping Record TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPARTMENT
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:
757 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
C&W Services/Stop & Shop
Name
140 Kendrick Street, Building C West, Suite 201
Address(if different from location)
Needham Heights MA 02494
Citylrown State Zip Code
5714342034 x
Telephone Number
B. Pumping Record
1. Date of Pumping 05/02/2022 2. Quantity Pumped: 8000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? 11Yes ❑X No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
Nn wager e-v Rip bottom sludge-. 8in top saliclsPath baffles re intact
Main line Clogged. No filter i5 present mi tlie tzinki uurLent tank is not des;iyned----
to be useEF—wiEE a filter. Cover s —secured. No 3rd party paperwork i e . Water
level normal mainline clear no filter present baffles intact moderate solids and
sludge pumped 8000 gallons of grease cover secured.
6. System Pumped By:
Geoffrey Howard
Name Vehicle license Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
"---N 05/02/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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