HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 2324 TURNPIKE STREET 10/18/2022 RECEIVED
If
Commonwealth of Massachusetts
City/Town of North Andover OCT 18 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:
2324 Turnpike St
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Little Sprouts Early Education & Child Care
Name
40 Strawberry Hill Road,
Address(if different from location)
Concord _ MA 01742
City/Town State Zip Code
9783762698 x
Telephone Number
B. Pumping Record
1. Date of Pumping 09/24/2022 2. Quantity Pumped: 2000.0000
Date Gallons
3. Component: Cesspool(s) 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:
Narmal watar > > 6 n h rr m 2ludge Bin top solids Both baffles are intact
tu—
be used with a filter. Cover(s) secured. No 3rd party paperwork i e . Remove
2000 gallons sludge and solids from primary tank. System is made up of a primary
tank secondary tank and pump chamber.
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:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
09/24/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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