HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 38 STONECLEAVE ROAD 5/3/2023 Commonwealth of Massachusetts aECE%vEo
City/Town of North Andover �2023
_ System Pumping Record vA,(
Form 4 DOTER
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the info ti .Must be'�M�N
substantially the same as that provided here. Before using this form,check with your local Board of h 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:
38 Stonecleave Rd
Address
North Andover MA 01845
City/Town State Zip Code__
2. System Owner:
Daniel Marotta
Name
38 Stonecleave Rd
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
5087371644
Telephone Number
B. Pumping Record
04/17/2023 1500.0000
1. Date of Pumping Date 2 Quantity Pumped: Gallons
3. Component: ❑ Cesspool(s) ❑X Septic Tank Tight Tank ❑ Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? ❑X Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine. Normal water level. Moderate top solids. Heavy bottom
sludge. Both baffles are intact. Main line Clear. Filter is present and has been
cleaned as needed. 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
"t— 04/17/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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