HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 44 BRUIN HILL ROAD 1/3/2024 Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record apN
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:
44 Bruin Hill Road
Address
North Andover MA 01845
City/Town State Zia Code
2. System Owner:
John Kelly
Name
44 Bruin Hill Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9788355516 xcell
Telephone Number
B. Pumping Record
1. Date of Pumping 11/10/2023 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) ❑X Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? F Yes 0 No If yes,was it cleaned? ❑X Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine. High water level. Moderate top solids. Heavy 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
Marcus Lark 11/10/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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