HomeMy WebLinkAboutSeptic Pumping Slip - 1801 Turnpike - Septic Pumping Slip - 9/16/2024 i
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Commonwealth of Massachusetts
I o 7 City/Town0f Forth Andover
System Pumping Record
Farm
D P 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 Isere.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 ether approving autherlty within 1
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days from the pumping date In accordance with 310 CUIR 15.35 1.
A, Facility Information
1. System Location;
1801 Turnpike Street �
Address
North Andover MA 01845I
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ity[Town ..State p Cade
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2.
System Owner:
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Direct Supply
Name
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7301 West Champions pions Way
Address if different from location)
Milwaukee DTI 53223
City/Town State Zip Code
7042820530
Telephone Number
B, Pumping Record
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'I. Date f Pumping � � � Quantity Pumped: �.000.000 {
Date Gallons
3. Component: Cesspool(s) Septic Tank 0 Tight Tank Grease Trap
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Other(describe):
. Effluent Tee Filter present? Yes FX-] No If fires, was It cleared? lies E] No
. observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
present. Tank cannot: be outfitted with f3. .ter. 1000 gallons removed. 2 inches of
bottom sludge. 2 inches f grease can. top. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped y:
Robert Herrick
Name Vehicle License dumber
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
Robert Herrick 224
Signature of Hauler Bate
Signature of Receiving Facility or attach facility receipt) Gate
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