HomeMy WebLinkAboutSeptic Pumping Slip - 325 Johnson - Septic Pumping Slip - 325 JOHNSON STREET 9/12/2024 I
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Commonwealth of Massachusetts
City/Town0f Forth Andover
r
} System Pumping Record
Fora
t
D P has provided this fora 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 fora
they use.The System Pumping Record rust be submitted to the local Board of Health or other approving authorliy W,lthin 1
days from the pumping date in accordance with 310 CMR 15.351.
A, Facility Information
1. System Location;
325 Johnson Street
Address
North Andover MA 01845
Cityrro rn State Zip Code
2. System owner:
Kevin Sparks
Dame
325 Johnson Street
Address if different from location)
North Andover MA 01845
ity[Town State Zip Code
9786828736
Telephone Number
B. Pumping Record
. Date of Pumping Quantity r Pumped:
DateGallons
. Component:ent: Cesspools Z septic Tangy Tight Tare Grease Trap
E] Other(describe):
. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
. Observed condition of component pumped:
Corer was accessed and properly secured. Septic system serviced.. Filter not
present. Tank cannot be outfitted with filter. 1000 gallons removed. Light sludge
n bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Main lino is clear.
. System Pumped y:
Marcus Lark
Dame Vehicle Ucense lumber
Wind t River Environmental, 46 Li otte Drive, Suite 1000, Marlborgugh, MA 01752
Company
. Location where contents were disposed;
Ipswich ' T ; 21. Fowlers Lane, Ipswich CIA 01938
Marcus Lark 0912/202
Signature of Hauler Cate
Signature of Receiving eiving Facility or attach facility receipt) Date
t formCdoc•1111 System Pumping record t Page 1 of'I