HomeMy WebLinkAbout- Septic Pumping Slip - 152 ABBOTT STREET 6/5/2023 R�MEN�
Commonwealth of Massachusetts
F City/Town of North Andover 2023
System Pumping Record 9UN 05
Form 4
^M 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:
152 Abbott Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
David Johnson
Name
152 Abbott Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9787711027
Telephone Number
B. Pumping Record
1. Date of Pumping 05/17/2023 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑ Tight Tank Grease Trap
❑X Other(describe): Not Applicable
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes, was it cleaned? ❑ Yes No
5. Observed condition of component pumped:
System not Operating Fine. High water level. Moderate top solids. Moderate bottom
sludge. Main line Clear. No filter is present on the tank; current tank is not
designed to be used with a filter. Cover(s) secured. Recommended Pump Repairs.
6. System Pumped By:
Michael Graham
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 Street, Bradford, MA 01835
05/17/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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