HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 78 EQUESTRIAN DRIVE 12/12/2022 RECEIVED
Commonwealth of Massachusetts
�} City/Town of North Andover WIUUVEE;
l� System Pumping Record TOHE THpEPARTN►ENT
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:
78 Equestrian Drive
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Marianne Jenkins
Name
80 Laconia Circle,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6179740002 x
Telephone Number
B. Pumping Record
1. Date of Pumping 10/17/2022 2. Quantity Pumped: 1250.0000
Date Gallons
3. Component: ❑Cesspool(s) Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? X❑Yes No If yes, was it cleaned? 2]Yes ❑ No
5. Observed condition of component pumped:
SI'StOrg Operating YinQ- NQrMal- Water Moderate top salids Moderate bottom
sludge. Buth bafftes dre intact. Main Itrie etedr. Ftiter is present and has been
cleaned as needed. over s secure The system is monolithic system there are two
concrete lids approximately six inches below grid system has a filter. How to
remove heavy tree roots from the inlet cover outlet cover is clear. Recommended
Boost additive,Wind River Septic System Treatment additive.
6. System Pumped By:
Ronnie Soucie III
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
10/17/2022
Sigriature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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