HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 672 SHARPNERS POND 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:
672 Sharpners Pond Road
Address
North Andover MA 01845
Cityrrown State Zip Code
2. System Owner:
Zhenlin Li
Name
672 Sharpners Pond Road
Address(if different from location)
North Andover MA 01845
Cityrrown State Zip Code
6508235098
Telephone Number
B. Pumping Record
1. Date of Pumping 04/03/2024 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? Yes n No If yes,was it cleaned? ❑ Yes No
5. Observed condition of component pumped:
Normal water level. Moderate top solids. Moderate 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. Repairs needed: Tank needs to
be replaced. At some point top of tank collapsed and was covered with wood and
concrete. Recommended Tank Replacement. Recommend using boost next pumping.
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:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
Robert Herrick 04/03/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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