HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 2324 TURNPIKE STREET 1/3/2024 Commonwealth of Massachusetts
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. - - 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:
2324 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Jesse Little Sprouts Early Education & Child Care
Name
40 Strawberry Hill Road
Address(if different from location)
Concord MA 01742
City/Town State Zip Code
7814206943
Telephone Number
B. Pumping Record
1. Date of Pumping 10/21/2023 2 Quantity Pumped: 2000.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑X Septic Tank ❑Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes,was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
Normal water level. 3in bottom sludge. 8in 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:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
Robert Herrick 10/21/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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