HomeMy WebLinkAboutSeptic Pumping Slip - 315 S. Bradford St TIC C
Commonwealth of Massachusetts A10V 2
City/Town of North Andover 2024
System Pumping Record °."�
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informat on&&t be�en
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine th"e`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:
315 South Bradford Street
Address
North Andover MA 01845
Citylrown State Zip Code
2. System Owner:
Michael Smolak Farms
Name
315 South Bradford,
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
9785002019 x
Telephone Number
B. Pumping Record
1. Date of Pumping 09/25/2024 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑Yes 0 No If yes,was it cleaned? Yes No
5. Observed condition of component pumped:
3 Bay Sink. 0 inches of grease on top. 6 inches of water. 6 inches of bottom
sludge. 35 gallons removed. Gasket is in good condition. Walls/bottom of trap in
good condition. System is at proper working level. Recommend increasing pumping
frequency. Left 0 bottles of drain master.
6. System Pumped By:
Amauary Leon I
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
Amauary Leon I 09/25/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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