HomeMy WebLinkAboutSeptic Pumping Slip - 315 Turnpike - 10/14/24 - Septic Pumping Slip - 10/14/2024 Commonwealth nfMassachusetts
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North Andover
VA
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 310CMR1m.351.
A. Facility Information
1. System Location:
315 Turnpike
North Andover MA 0I845
2. System Owner:
Caoella Oz i
Name
283 Smith Road
NY 12920
City/Town State Zip Code
6O�29O5835
Te|ephoneNumbe,
B. Pumping Record
I0/14/2034 3500.0000
1. D�teofPumping Date2 Quantity Gaxnns
3. Component: [—lcesspool(s) F-1 septic Tank [—1 Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? [—lYes No |f yes, was kcleaned? []Yes RNo
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
pzeaeot, Tank cannot be outfitted with filter. 3508 gallons removed. 2 ionbeo of
bottom sludge. 2 inches of grease on top, l inches of water. System is at grnPez
working level. Maio line is clear. None.
G. System Pumped By:
Jerald BziIhaote
Nam* Vehicle License Number
Wind Riveri 6 i i i l000 l O 752
Company
7. Location where contents were disposed:
Vanguard R bl 3 � �io Digester: 56 Northwest Road, Spencer
Jerald Bcilbaote 10/14/2024
Signamvao,*av|e, m^�
miBnamnem Receiving Facility(or attach facility receipt) omm