HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 700 MIDDLETON STREET 1/8/2024 Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record
Form 4 be
Health.Other forms may be used,but the information must
DEP has provided this form for use by local Boards of determine
substantially the same as that p Redo d must be e. subm'tt d t I the local Board s form,check with
Health orlother approving Board of l authority within h 14 form
re usin
they use.The System Pumping
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
698 Middleton Road
Address 01845
North Andover MA
State Zip Code
City/Town —
2. System Owner:
Commonwealth Dept. DCR Northeast Region
Name
25 Shattuck Street
Address(if different from location) 01852
Lowell MA
State Zip Code
City/Town 9784657223
Telephone Number
B. Pumping Record
08/04/2023 5000.0000
1. Date of Pumping Date 2• Quantity Pumped: Gallons
3. Component: FjCesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes 0 No If yes,was it cleaned? 0 Yes No
5. Observed condition of component pumped:
Normal water level. 3in bottom sludge. 5in top solids. 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. No 3rd party paperwork filled.
6. System Pumped By:
Michael Graham
Vehicle License Number
Name
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
South essex sewerage district: 50 Fort Ave, Po Box 989, Salem , MA 01970
-. 08/04/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
System Pumping Record•Page 1 of 1
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