HomeMy WebLinkAboutSeptic Tank - Miscellaneous - 64 NORTH CROSS ROAD 3/5/2024 Commonwealth of Massachusetts
u City/Town of North Andover
' System Pumping Record �a �4�
Form 4
^M DEP has provided this form for use by local Boards of Health.Other forms may be used,butt information mutt f
e
substantially the same as that provided here. Before using this form,check with your local Board of Health a rmine the orm
they use.The System Pumping Record must be submitted to the local Board of Health or other approvin4ority within 1�} r"i�
days from the pumping date in accordance with 310 CMR 15.351. r�
A. Facility Information
1. System Location: ''
64 North Cross Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Patrick Wilver
Name
64 North Cross Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9784602357
Telephone Number
B. Pumping Record
1. Date of Pumping 02/05/2024 2 Quantity Pumped: 1000.0000
Date Gallons
3. Component: ❑ Cesspool(s) F Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? M Yes ❑X No If yes, was it cleaned? Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine. Normal water level. Light top solids. Moderate bottom
sludge. 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. Pumped 1000
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:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
Marcus Lark 02/05/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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