HomeMy WebLinkAboutSeptic Pumping Slip - 75 Granville Ln n n
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Commonwealth of Massachusetts
City/Town of North Andover NOV 2 6 2024
System Pumping Record
Form 4 H .
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DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information m�tst�e
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:
75 Granville Lane
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Michael Sierpina
Name
75 Granville Lane
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9789959835
Telephone Number
B. Pumping Record
1. Date of Pumping 09/23/2024 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) 0 Septic Tank TightTank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? R Yes 0 No If yes,was it cleaned? Yes ❑ No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank cannot be outfitted with filter. 1500 gallons removed. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Main line is clear. 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 09/23/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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