HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 58 PHEASANT BROOK ROAD 5/7/2024 Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record
Form 4
'M 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:
58 Pheasant Brook Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
John McCormick
Name
58 Pheasant Brook Road
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
9787712454
Telephone Number
B. Pumping Record
04/08/2024 1500.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: cesspool(s) Septic Tank Tight Tank ❑ Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑X Yes No If yes,was it cleaned? ❑X Yes ❑ No
5. Observed condition of component pumped:
System Operating Fine. Normal water level. Light top solids. Light bottom sludge.
Both baffles are intact. Main line Clear. Filter is present and has been cleaned
as needed. Cover(s) secured. Recommended Installing a riser. Recommend adding
Treatment. Please visit https://portal.wrenvironmental.com/ to purchase online.
6. System Pumped By:
Jonathon Colson
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
Jonathon Colson 04/08/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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