HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 71 JOHNNY CAKE STREET 7/18/2022 R�GE�vE
Commonwealth of Massachusetts
City/Town of North Andover �U` 1g2021
System Pumping Record Oa1HANDO
Form 4 To*%r4 Of 'PW1M0N
M DEP has provided this form for use by local Boards of Health.Other forms may be used,but the inforrtta &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:
71 Johnnv Cake Street
Address
North Andover MA 01845
Citylrown State Zip Code
2. System Owner:
Joe Mcgoldrick
Name
71 _Johnny Cake Street
Address(if different from location)
North Andover MA 01845
City/Town state Zip Code
9787642519 xcell
Telephone Number
B. Pumping Record
1. Date of Pumping Date 06/06/2022 2. Quantity Pumped: Gaallonsllons 000
3. Component: Cesspool(s) FJW� 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:
System Operating Pine Narmal watero.,oi moderate top solids Moderate bottom
siudge. Botli baffles dre intact. Matn iine etear. No filter is present oil tile tank,
current tan —isno-t--designed to be used with a filter. Cover s secure .
Recommended Boost additive,CCLS 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:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
—� 06/06/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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