HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 143 LACY STREET 8/3/2023 Commonwealth of Massachusetts n
City/Town of North Andover AtIG 23
System Pumping Record 3
Form 4
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:
143 Lacy Street
Address
North Andover MA 01845
City/Town State Zip Code _
2. System Owner:
Steph O'Mahony,
Name
143 Lacy Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6175937917
Telephone Number
B. Pumping Record
1. Date of Pumping 07/07/2023 2 QuantityPumped: 1500.0000
p g Date p Gallons
3. Component: F1 Cesspool(s) Septic Tank ❑ Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑X Yes ❑ No If yes, was it cleaned? ❑X Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine. Normal water level. Heavy top solids. Moderate 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:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
07/07/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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