HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1801 TURNPIKE STREET 8/3/2023 Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record
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:
1801 Turnpike St
Address
North Andover MA 01845
City/Town State Zia Code
2. System Owner:
Direct Supply
Name
6767 North Industrial Road,
Address(if different from location)
Milwaukee WI 53223
Cityrrown State Zip Code
8882257729 x
Telephone Number
B. Pumping Record
03/10/2023 1000.0000
1. Date of Pumping - -- 2. Quantity Pumped.
Date Gallons
3. Component: Cesspool(s) F Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes, was it cleaned? 11 Yes ❑ No
5. Observed condition of component pumped:
Normal water level. 1000in bottom sludge. 1000in top solids. Both baffles are
intact. Main line Clear. No filter is present on the tank; current tank can be
outfitted with a filter. Cover(s) secured. No 3rd party paperwork filled. 1000
gallons removed no Further recommendations checked in 11:53am checked out at
12:38pm with the phone number That was provided by the company.
6. System Pumped By:
Ronnie Soucie III
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
03/10/2023 _
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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