HomeMy WebLinkAboutSeptic Pumping Slip - 240 Old Cart - 10/1/24 - Septic Pumping Slip - 240 OLD CART WAY 10/1/2024 Cn00Ol{]nVVeaHh of Massachusetts
C' Onf North Andover
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� u���U��� Rec
ord
F� — 4 Pumping
orm
DEP 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 14
days from the pumping date in accordance with 31UCMg1s.3o1.
A. Facility Information
1. System Location:
340 Old Cart Way
Address
North Andover MA 01845
CuyfTown State Zip Code
2. System Owner:
Paul Harty
Name
240 Old Cart Way
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9787941106
Telephone Number
B. Pumping Record
I0/0I/2024 2000'0000
1. Dataof�umping Dam 2. Ouentitypumped� Gaoonm
3. Component: F] cemepoo|(m) Septic Tank [—�Tight Tank F—lGrease Trap
Other(describe):
4. Effluent Tee Filter presant? F—1 Yes F�lNo |f yes,was itcleaned? [—]Yes [—lNo
5. Observed condition of component pumped-
Cover was accessed and ezopezzv secured. Septic system serviced. Filter not
present. Tank cannot be outfitted with filter. 2000 gallons removed. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Maio line is clear.
G. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000 Marlborough, em 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street morth Andover, Mn
marooa Lark I0/01/2024
Signature ufHauler Date
Signature cx Receiving Facility(or attach facility receipt) Date
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