HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 10 CROSSBOW LANE 12/12/2022 aec��vEr�
, Commonwealth of Massachusetts
City/Town of North Andover
m _ System Pumping Record TOWN OF NORM M NTER
Form 4 HEA��y t OEFpH
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:
10 Cross Bow Lane
Address
North Andover MA 01845
Citylrown State Zip Code
2. System Owner:
Jay Marconi
Name
10 Cross Bow Lane
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
5088891482
Telephone Number
B. Pumping Record
1. Date of Pumping 10/18/2022 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: El Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑Yes FK-] No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine Normal- water level- Heavy top solids Heavy bottom sliidge
Both baffles are tatdc;t. Main lime Clear. No ftiter is present oil tile tdnki current
tank is not designed to be used with a filter. Cover(s) secured. Shut the tank is
directly in front of the back porch porches Brown 2 inches below grade both the
inlet and outlet cover. Tanks had approximately 18 in of top solids and 12 inches
of sludge on the bottom tank could benefit from a boost combination spoke with the
+ mo ao a; —AA;+;,.o� ,� +r o + + ..;, + poi i +t o r,.,— r
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
10/18/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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