HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 336 SHARPNERS POND ROAD 7/18/2022 RECEIVED
� Commonwealth of Massachusetts
City/Town of North Andover JUL 1 S 2022
System Pumping Record TOWN OF NORTH ANDOVER
r` 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:
336 Sharpners Pond Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Ellen & Brian Fitzgerald
Name
336 Sharpners Pond Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9782586272 xhome
Telephone Number
B. Pumping Record
1. Date of Pumping 06/09/2022 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) 0 Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑X Yes ❑ No If yes, was it cleaned? 0 Yes ❑ No
5. Observed condition of component pumped:
System_Operating Fine High water level Moderate tcp—solids Moderate bottom
beerr—
cleaned as needed. Cover s secured. 1000 gaiions septic cover secured. Recommended
Installing a riser,New Cover.
6. System Pumped By:
Boyd Brewington
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
�!1 06/09/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11112 System Pumping Record•Page 1 of 1