HomeMy WebLinkAboutSeptic Pumping Slip - Septic Pumping Slip - 1264 OSGOOD STREET 9/30/2024 i
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Commonwealth of Massachusetts
City/Town0f North Andover
System Pumping Record
Form 4
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Eli 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 1
days from the pumping date in accordance with 310 CM R 15.351.
A, Facility Information
1. System Location:
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164 0sg.qqd Street
Address }
North Andover MA 01845
City/Town State Zip Coda
. System Owner:
Starbcs
Name
85 Wells Arne, Suite 110
Address(if different from location)
Newton Center MA 059
itylTwn State Zip Code
58477506
Telephone Number i
B. Pumping Record
09/30/2024 200.0000
. Date of Pumping t . Quantity Pur ped: gallons
3. Component: Cesspool(s) Septic Tank Tight Tank 7 Grease Trap
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❑ Other(describe):
. Effluent Tee After present? ❑Yes No If yes, was it cleaned? Yes ❑ o
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. observed condition of component pumped:
Cover was accessed and properly secured. 3 Bay Sink. 10 inches of crease on top. 4
inches of water. 10 inches of bottom sludge. 100 gallons removed. Both
baffles/tees are intact. 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. 2 traps, one 40 gallon trap, 1 10
. System Pumped y:
Joshua Melend
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
. Location where contents were disposed:
Water Solutions ns Group: 35 Mozzone Blvd Taunton, MA 02780
Liam Brown09/30/2024
Signature of Hauler Date
Signature of Receiving eivin Facility or attach facility receipt) late
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