HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 263 CANDLESTICK ROAD 10/18/2022 RECEIVED
Commonwealth of Massachusetts OCT 18 2022
City/Town of North Andover TOWN OF NORTH ANDOVER
System Pumping Record HEALTH DEPARTMENT
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:
263 Candlestick Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Mary Nania -
Name
263 Candlestick Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786856629 xhome
Telephone Number
B. Pumping Record
1. Date of Pumping 09/19/2022 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? ❑Yes No
5. Observed condition of component pumped:
System operating Fine- Normal water leval Tight to solids Moderate bottom
51udge. But:11 baffles Mail, line ej:ed.L. No fjjte.L j.-j jiLt,,,it an the tank;
current tank is not designe to e used with a i ter. Covers secured. Pumpe
1500gallons. Recommended No Recommendation.
6. System Pumped By:
Marcus Lark
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
+ 09/19/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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