HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 74 SHERWOOD DRIVE 10/3/2022 „ e'ewev
Commonwealth of Massachusetts pcj q's
City/Town of oaTH ANo NT
North Andover ToW4 IDSOS1W
_ a System Pumping Record w�
_ Form 4
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:
74 Sherwood Drive,
Address
North Andover MA 01845
City/Town State _ Zip Code
2. System Owner:
Patrick Gallagher
Name
74 Sherwood Drive,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7817894621 x
Telephone Number
B. Pumping Record
1. Date of Pumping 08/18/2022 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) ❑W Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑Yes ❑X No If yes, was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
N ai ate bevel Moderate to solids Moderate hottom sludge 9utiet hat€las are
tntact. Main time- Cledr. No fitter is present un the tank; cunrent tank is not
designed to be used with a filter. over s secured. Removed 1500 gallons.
Recommended No Recommendation.
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
�'✓” 08/18/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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