HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1200 SALEM STREET 6/3/2024 <�, 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:
1200 Salem Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Kathleen Hajjar
Name
1200 Salem Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9788848384
Telephone Number
B. Pumping Record
1. Date of Pumping 06/03/2024 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) FX-] Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes Z 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 is not designed to be used with a filter. Cover(s) secured.
Recommended No Recommendation. Recommend using boost next pumping.
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:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Jonathon Colson 06/03/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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