HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1980 TURNPIKE STREET 1 3/6/2023 Commonwealth of Massachusetts
City/Town of North Andover
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System Pumping Record �N00ve'�
Form 4 `�� C�PRiEN
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the ir#Wf1`h4 tSe
substantially the same as that provided here.Before using this form,check with your local Board of H�}�It 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:
1980 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Affinity Realty Property Managment
Name
63 Atlantic Avenue
Address(if different from location)
Boston MA 02110
City/Town State Zip Code
9786949399
Telephone Number
B. Pumping Record
1. Date of Pumping 02/03/2023 2. Quantity Pumped: 3500.0000
Date Gallons
3. Component: Cesspool(s) ❑X Septic Tank ❑Tight Tank ❑Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑X Yes ❑ No If yes, was it cleaned? FJV—]Yes ❑ No
5. Observed condition of component pumped:
Normal water le of inn; b, i-i m �i„-aqo inn;„ i-z sviids Roth baffles are intact
secured. No 3rd party paperwork tilled. ne hose required to complete job there are
four caps tank the third cap is stuck tank is one hole tank one chamber top solids
12 in bottom sludge 18 in. Remove 3500 gallons. No further recommendation.
6. System Pumped By:
Ronnie Soucie III
Name Vehide 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
02/03/2023
Signa ure of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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