HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 295 CANDLESTICK ROAD 12/12/2022 RECEtvE®
Commonwealth of Massachusetts
City/Town of North Andover ��OF 1a06T ANppVE4
a _ _ System Pumping Record �oH �T�cEPAIRIMENT
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:
295 Candlestick Road,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
SergeV Beddenin
Name
295 Candlestick Road,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6174290294 x
Telephone Number
B. Pumping Record
1. Date of Pumping 11/01/2022 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 FK-] No If yes,was it cleaned? ❑ Yes F1No
5. Observed condition of component pumped:
siudye. Buth baffies are trit�tct. Main line Clear. No fill- J11t on the System ngt Operating Fine- Normal watar Moderate t,op solids Moderate bottom
current tan is not designed to be used with a filter. Cover(s) secured. You have
access to the driveway job requires two hoses and 1-15 ft short tank is 12 in below
grade there was approximately 12 in of top solids and 8 inches of bottom sludge
tank could benefit from a boost combination diagram available if needed. Two small
rho „rn.,onr.. n -+t c ...ill r,„F Anna .o, Fnr ....,, D-------A.A
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:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
11/01/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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