HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 267 OLD CART WAY 12/12/2022 RECENEL'
Commonwealth of Massachusetts
City/Town of North Andover N,�2
System Pumping Record
NUR'CH ANDOVEh
Form 4 TOW..1NpOF DEPARTMENT
DEP has provided this form for use by local Boards of Health.Other forms may be used,but tl1A "formation 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:
267 Old Cart Way
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Lisa Reichlen
Name
267 Old Cart Way
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6033611212
Telephone Number
B. Pumping Record
1. Date of Pumping 10/05/2022 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: ❑ Cesspool(s) a Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes D No If yes, was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
System operating Fine Normal watar i o of Moderate top solids Moderate faot;tam
sludge. Buth bdffle5 dre iiirdct. Main tine CJ:edr. No fittt.1L ..LZ, JJLt�bt=-Ilt U11 tile td1rk—,
current tank is not designed to be used with a filter. Covers secured.
Recommended Boost additive,Wind River Septic System Treatment additive.
6. System Pumped By:
Michael Graham
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
10/05/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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