HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 236 SUMMER STREET 1/25/2023 RECEIVED
—°�_- -- Commonwealth of Massachusetts JAN 2 5 ZK3
u� City/Town of North Andover
1 System Pumping Record TCHE ATHD PAR IMOFt
OF MEN�E�
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:
236 Summer Street,
Address
North Andover MA 01845
Cit /Town
y _State --- — — —�--- e-- ---
2. System Owner:
Rob Wu -- - - - -
Name
236 Summer Street,
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
7817758029 x
Telephone Number
B. Pumping Record
1. Date of Pumping 12/13/2022 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 No If yes, was it cleaned? Yes R No
5. Observed condition of component pumped:
S-yst,e=-0parat ing--FJ ne.-._Normal--wa-ter Heay-tsp-sol-ids--1 rate-_1agt;.tam -—..._..
sludge. Buth baffies dre intact. MCL-'LIL iillt� elear. No fiitei is present an the tank;
current tank is not designed to be used with a filter. Cover(s) secured. Pumped
1500 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:
HaverHill Disposal Site: 40 s Porter St, Bradford, MA 01835
"'& 12/13/2022
Si nature of Hauler Date
-- — — - - - ---------
Signature of Receiving Facility(or attach facility receipt) Date
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