HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 54 TUCKER FARM ROAD 5/7/2024 12
Commonwealth of Massachusetts
City/Town of North Andover
o 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 getesmine the form
they use.The System Pumping Record must be submitted to the local Board of Health or other approving aotlioi within 14
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location: MQ� 7 2024
54 Tucker Farm Road
Address
North Andover MA
City/Town State LA Pa Zip Code
2. System Owner:
Mike Mead
Name
54 Tucker Farm Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
7812492786
Telephone Number
B. Pumping Record
1. Date of Pumping 04/24/2024 2 Quantity Pumped: 1500.0000
Date Gallons
3. Component: cesspool(s) 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:
System Operating Fine. Normal water level. Heavy top solids. Heavy bottom sludge.
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. 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:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Marcus Lark 04/24/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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