HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 143 PHEASANT BROOK ROAD 12/12/2022 �IECEIVED
<L\ Commonwealth of Massachusetts
City/Town of North Andover
n System Pumping Record ,�41ANDOVER
— ,:'d iMENT
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:
143 Pheasant Brook Road
Address
North Andover MA 01845
Citylrown State Zip Code
2. System Owner:
Stephanie Lamarca
Name
143 Pheasant Brook Road,
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
9787380098 x
Telephone Number
B. Pumping Record
1. Date of Pumping 11/09/2022 2 Quantity Pumped: 1500.0000 _
Date Gallons
3. Component: Cesspool(s) ❑W Septic Tank ❑Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑Yes N] No If yes, was it cleaned? ❑ Yes No
5. Observed condition of component pumped:
System Operating Fine Normal I-later le'rel Heavy top salids Light bQttom gliudge
Buth bdffles axe inta(;t. Main lin filter is present: on tile tciilkr current
tank is not designed to be used with a filter. Cover s secured. Tank is in the
front of the house in the mulch bed by the front door 2 in below the mulch there
are two hoses required to complete this job there was a heavy mat across the entire
tank 12 to 14 in thick had to backwash tank. Tank would benefit from a boost
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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
11/09/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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