HomeMy WebLinkAboutSeptic Pumping Slip - 93 Turnpike - 10/02/2024 - Septic Pumping Slip - 93 TURNPIKE STREET 10/2/2024 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 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 31nCmn1n.as1.
A. Facility Information
1. System Location:
93 Turnpike Road
Address
North Andover MA 01845
City/Town State zip�e
2. System Owner:
Rubicon
Name
125 Half Mile Road Suite 201
Address(if different from location)
Bed Bank NJ 0770I
City/Town State Zip Code
7322753434
Telephone Number
B~ Pump~ng Record
lO/02/2O24 I08.0000
1. D�b*pf�umping Dam 2� Quantity Pumped: GoUvno
3. Component [—lCesspool(s) Septic TankF—1 Tight Tank FX—]GneaaeTnap
F-7 Other(deecribe):
4. Effluent Tee Filter present? [—1 Yes �� No |f yes, was kcleaned? F—1 Yes [—lNo
5. Observed condition of component pumped:
Cover was accessed and properly secured. s Bay Sink. 6 inches of grease on tog. x
ioouea of water. o inches of bottom sludge. oo gallons removed. Both baffles/tees
are intact. Gasket is in good condition. walla/bottom of trap in good condition.
System is at proper working level. Left 0 bottles of drain master. ooH Logo
Signed.
G. System Pumped By:
Raymond Saez
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, i OOV, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd Taunton, MA 02780
Raymond Saez 10/02/2024
Signature orHauler Date
Gignamnsuf Receiving Facility(or attach facility receipt) navy
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