HomeMy WebLinkAboutSeptic Pumping Slip - 106 Boston St - 10/23/24 - Septic Pumping Slip - 106 BOSTON STREET 10/23/2024 Commonwealth of Massachusetts
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:
106 Boston Street
Address
North Andover MA 01845
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2. System Owner:
Pierre Ezzie
Name
106 Boston Street
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Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
5086312124
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Telephone Number
B. Pumping Record
10/23/2024 1500.0000
1. Date of Pumping ..................... 2. Quantity Pumped: _
Date -Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-1 Yes "N/ No If yes,was it cleaned? F-1 Yes F—] No
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5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank cannot be outfitted with filter. 1500 gallons removed. Light Sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Main line is clear. Recommend using boost next
pumping. Adding treatment between now and then will improve the health of your
6. System Pumped By:
Robert Herrick
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Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough,—MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street North Andover, MA
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Robert Herrick 10/23/2024
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Signature of Hauler Date
SignatureofRecWi�i7n`g--F"adlity—(or atta-c-h--f-a,-c-i-l-it-,y,--r,-e-,c-eip—t)-----------
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