HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 315 BERRY STREET 12/12/2022 RECEIVED
Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record TOHEA ZH��ppRTMENTt~
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:
315 Berry Street,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Michael Santangelo
Name
315 Berry Street,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7819537304 x
Telephone Number
B. Pumping Record
1. Date of Pumping 10/18/2022 - 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑Yes 0 No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
System operating Fing Normal r Ig l Moderate top solidsMod-rate bottom
studge. Buth baffles dre intdct. Main line Clear. No filt— IS 1--lit 011 tile tct
current tank is not designed to be used with a filter. Cover(s) secured. The tan
is located in the back of the house off the corner of the deck opposite side of the
house from the driveway you will need four hoses for this job. Make sure you close
the gate when you leave the property there is a small white dog on the property and
�l l nh4 l A— T 4—1�.4-4 � nc.o A;�nr�m nF the -----rt.. Dcn---- ]crl Rnnct
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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