HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1265 SALEM STREET 8/5/2024 Commonwealth of Massachusetts
— City/Town of North Andover
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 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:
1265 Salem Street,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Allison Halleck
Name
1265 Salem Street,
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
6172339903
Telephone Number
B. Pumping Record
1. Date of Pumping 07/01/2024 2 Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑Tight Tank ❑ Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑ Yes F No If yes, was it cleaned? Yes n 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. No filter is present on the tank;
current tank is not designed to be used with a filter. Cover(s) secured.
Recommended No Recommendation.
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:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
Jonathon Colson 07/01/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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