HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 85 COLONIAL AVENUE 1/25/2023 RECE1vED
Commonwealth of Massachusetts 5 202'3
City/Town of North Andover
System Pumping Record TOWN0FWIRTV,'T N-f
y
Form 4 HEALTH DEFP,
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:
85 Colonial Avenue,
Address -
North_ Andover MA 01845
City/Town State Z&Code
2. System Owner:
Jeff Castaldo
Name --
85 Colonial Avenue,
Address(if different from location)
North Andover MA 01845
Cityrrown State Zip Code
9785094846 x__
Telephone Number
B. Pumping Record
12/07/2022 1500.0000
1. Date of Pumping -- 2. Quantity Pumped: - — ---------
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? D Yes 0 No If yes, was it cleaned? ❑ Yes No
5. Observed condition of component pumped:
ine----.-N"ma-1_wate-r--l-evel,.- Heavy—top---soJ-i4L%_—Heauy_ bat am.-sludge!— -
Buth bafftes dLe intact. maill line elea.z. No fitter is Present oil the tdiiki cuzzent
tank is not designed to be used with a filter. Cover(sY secured. Pumped
gallons. Recommended No Recommendation.
6. System Pumped By:
Marcus Lark
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
12/07/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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