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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 111 BROOKVIEW DRIVE 3/6/2023 �EG��vEO Commonwealth of Massachusetts City/Town Of North Andover System Pumping Record f Form 4 �� �U•ti�,.. ,=.A" DEP has provided this form for use by local Boards of Health.Other forms may be used,but the infomlditlorrmust 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: 111 Brookview Drive Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Julie Ruhland Name 111 Brookview Drive Address(if different from location) North Andover MA 01845 City/Town State Zip Code 9785093371 Telephone Number B. Pumping Record 1. Date of Pumping 02/27/2023 2. Quantity Pumped: 1500.0000 Date Gallons 3. Component: ❑ Cesspool(s) a Septic Tank Tight Tank Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? Yes ❑X No If yes, was it cleaned? Yes ❑ No 5. Observed condition of component pumped: System Operating Fine. Normal water level. Moderate top solids. Moderate bottom sludge. Both baffles are intact. Main line Clear. No filter is present on the tank; current tank is not designed to be used with a filter. Cover(s) secured. Drive to highlighted ridge you have access to customers driveway on this property Septic tank is located behind the house green fiberglass lid on the surface 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: NENO Yard: 163 Western Ave, Gloucester, MA 01930 02/27/2023 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1