HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 240 OLD CART WAY 7/7/2023 Commonwealth of Massachusetts
City/Town of North Andover N� 0-0110'L�
a System Pumping Record
1
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
th your
substantially the same as that provided or must be e. submitted tore using s form,check the local Board'of Health orlother approving Health
authority within 14 form
they use.The System Pumping
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. system Location:
240 Old Cart Way
Address 01845
North Andover MA
State Zip Code
City/Town -
2. System Owner:
Paul Hart
Name
240 Old Cart Way
Address(if different from location) 01845
North Andover St
State Zip Code
City/Town 9787941106
Telephone Number
B. Pumping Record
06/13/2023 2000.0000
1. Date of Pumping Date 2• Quantity Pumped: Gallons
3. Component: cesspool(s) � Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes 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.
Pumped 2000 gallons. Recommended No Recommendation.
6. System Pumped By:
Marcus Lark
Vehicle License Number
Name
rive, Suite 1000, Marlborough, MA 01752
Wind River Environmental, 46 Lizotte D
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
06/13/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
System Pumping Record•Page 1 of 1
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