HomeMy WebLinkAboutSeptic Pumping Slip - 80 Laconia - 10/9/24 - Septic Pumping Slip - 80 LACONIA CIRCLE 10/9/2024 Commonwealth of Massachusetts
.4 City/TownOf North Andover
System Pumping Record
.............. Form 4
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 310 CMR 15.351.
A. Facility Information
1. System Location:
80 Laconia Circle
Address
North Andover MA 01845
City/Town -State ZjpLCq e..
2. System Owner:
Marianne Jenkins
Name
80 Laconia Circle
i -(iff different from location)
'- "--------- -__-------
Address North Andover MA 01845
------.................................. ................ ... -------------------
City/Town State Zip Code
6179740002
.....................
Telephone Number
B. Pumping Record
10/09/2024 1500.0000
1. Date of Pumping 2. Quantity Pumped: ------
Date Gallons
3. Component: F1 Cesspool(s) Septic Tank Tight Tank r-]Grease Trap
F-� Other(describe):
4. Effluent Tee Filter present? FXJ Yes D No If yes,was it cleaned? Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 1500 gallons removed. Moderate sludge on bottom of tank. Moderate
amount of top solids in tank. System is at proper working level. Both baffles/tees
are intact. Main line is clear. None.
6. System Pumped By:
Marcus Lark
Name----------------------------- Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborqjjgh, ..MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
Marcus Lark 10/09/2024
i-�n �---- a--"- —--------------------------§gature of Hauler
Date
- -eofRe- .. - --- ----- ----------
------- .......................
ignaiur Receiving Facility(or attach facility receipt) Date
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