HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 129 FOREST STREET 5/3/2023 Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record
/, Form 4 n,4 ORC \� ENS
DEP has provided this form for use by local Boards of Health.Other forms may be used, but the infofic 0)n!�
substantially the same as that provided here. Before using this form,check with your local Board dNA*q\O deermine 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:
129 Forest Street
Address
North Andover MA 01845
City/Town State Zip Code __
2. System Owner:
Paul Tricket
Name
129 Forest Street
Address(if different from location)
North Andover MA 01845
City[Town State Zip Code
9786973900
Telephone Number
B. Pumping Record
04/06/2023 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? ❑ Yes a No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine. Normal water level. Heavy top solids. Heavy 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. Pumped
1500 gallons. Recommended Frequency Increase.
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
04/06/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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