HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 54 TUCKER FARM ROAD 12/12/2022 BECENED
Commonwealth of Massachusetts - >
City/Town of North Andover 40ovevi
System Pumping Record =`
Form 4 , . N
M 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:
54 Tucker Farm Road
Address
North Andover MA 01845
Citylrown State Zip Code
2. System Owner:
Mike Mead
Name
54 Tucker Farm Road
Address(if different from location)
North Andover MA 01845
CityfTown State Zip Code
7812492786
Telephone Number
B. Pumping Record
1. Date of Pumping 10/25/2022 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 ❑) No If yes,was it cleaned? Yes No
5. Observed condition of component pumped:
System Operating F_ Normal- wate,- level Moderate top solids moderate modarate hattam
studge. Both baffies cat: intact. Maiii line Ciedr. Nu filt— IS U11 the ,
current tank is not designed to be used with a filter. Cover s 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:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
% 10/25/2022 _
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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