HomeMy WebLinkAboutSeptic Pumping Slip - 409 Forest St - 10/15/24 - Septic Pumping Slip - 409 FOREST STREET 10/15/2024 Commonwealth nfMassachusetts
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oEP 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 a1VCMR1s.us1.
A~ Facility Information
1. System Location:
409 Forest Street,
*4orem
North Andover MA 01845
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2. System Owner:
Claire
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409 Forest Street,
Address(if different from location)
North Andover 01845
City/Town State Zip Code
9786883615 o
Telephone Number
B. Pumping Record
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1 Date 2 Quantity' Date ' � Gallons
3. Component cesspool(s) Septic Tank F]Tight Tank F-]Grease Trap
[—1 Other(deschbe):
4. Effluent Tee Filter present? F—| Yes F�lNo |f yes,was itcleaned? [—lYes [-1No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank oauunt be outfitted with filter. 1800 gallons removed. Light sludge
on bottom of tank. Moderate amount of too solids in tank. System is at proper
working level. Both baffles/tees are intact. Maio line is clear. moue.
S. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlbo-r.o.ucth., MA 01752
Company
7. Location where contents were disposed:
0END Yazd; 163 Western Ave, Gloucester, M& 0I930
Mac000 Lark I0/15/2024
Signature orHauler Date
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