HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 48 SUNSET ROCK ROAD 7/18/2022 DECEIVED
Commonwealth of Massachusetts �U` 18 2p22
City/Town of North Andover
a System Pumping Record TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPAaTMENT
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:
48 Sunset Rock Road
Address
North Andover MA 01845
Cityrrown State Zip Code
2. System Owner:
Margaux Crabtree
Name
48 Sunset Rock Road,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
4134461876 x
Telephone Number
B. Pumping Record
1. Date of Pumping 06/20/2022 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 ❑X No If yes, was it cleaned? El Yes No
5. Observed condition of component pumped:
System operating Fine- Normal water level- Moderate tGp sal-ids Moderate bottom
current tank is not designed to be used with a filter. Cover s secured. Remove
1500 gallons. Recommended Boost additive,Wind River Septic System Treatment
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
06/20/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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