HomeMy WebLinkAboutSeptic Pumping Slip - 131 Crickett - Septic Pumping Slip - 131 CRICKET LANE 9/6/2024 c
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Commonwealth of Massachusetts }
{ City/Town Of Forth Andover }
M TM
System Pumping Record
Form
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 sane 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 15351.
A. Facility Information
1 System Location:
131 Crickett Lane
Address
North Andover MA 01845 '
City/Town -state............. dip Code
2. System Owner:
Rex Pela
Name
11 Criokett Lane
Address(if different from location)
North Andover MA 01845
CitylTown state Zip Code
9788524163
Telephone Number
B. Pumping Record
09 24 1500.0000
. Date of PumpingDate 2. Quantity Pumped: gallons
. Component Fj Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
. Effluent Tee Filter present? Yes No If fires, was It cleaned? lies No
5. Observed condition of component pumped:
System Operating Fine. Normal water level. Light top solids. Moderate bottom
sludge. Both baffles are intact. Main line Clear. Filter is Present and has been
cleaned as needed. Corer secured. Recommended No Reoommend.a.ti.on.
. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Li otte Drive, Suite 1000, Marlborough, MA 01752
Company
. Location where contents were disposed:
South essex sewerage district: 50 Fort Ave, Po Box 989, Salem MA 01970
Robert Herrick 0904
Signature of Hauler Date
Signature of Receiving Facility or attach facility receipt) Date
t form .doe•11/12 System Pumping Record•Page 1 of I