HomeMy WebLinkAboutSeptic Pumping Slip - 78 Equestrian - 10/9/24 - Septic Pumping Slip - 78 EQUESTRIAN DRIVE 10/9/2024 Commonwealth nfMassachusetts
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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 ao that provided here.Before using this form,check with your local Board o(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 31OCmn1a.a51.
A. Facility Information
1. System Location:
78 Equestrian Drive
Address
North Andover Ma 01845
City/Town State Zii Code
2. System Owner:
Marianne Jenkins
Name
BO Laconia Circle
NorthAddress(if different from location)
Andover Mn 01845
City/Town State Zip Code
6179740002
_ Telephone Number
B~ Pump.ng Record
10/09/2024 I250 0000
1. �eteofPumping Date �. Quantity Gallons
3. Component [—lCeoepooKo> septic Tank [—1 Tight Tank F—1 Grease Trap
Other(describe):
4. Effluent Tee Filter present? FXJ Yes F] No |f yes, was itcleaned? Yes nNo
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 1500 9azzouo removed. Heavy ozouge on bottom of tank. Light toe
aoziuo in tank. System is at proper working level. Both baffles/tees are intact.
Main line is clear. moue.
G. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000 Marlborough, M& 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street North Andover, MA
Marcus Lark
I0/09/2024
Signature ofHauler Date
Signature xr Receiving Facility(or attach facility receipt) Date
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