HomeMy WebLinkAboutSeptic Pumping Slip - 535 Chickering - Dunkin - 10/31/24 - Septic Pumping Slip - 535 CHICKERING ROAD 10/31/2024 Commonwealth nfMassachusetts
C' nnf North Andover
System Pumping
Record
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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 mOCMR15.351.
A. Facility Information
1. System Location:
^ud^emm
North Andover M8 01845
City/Town
2. System Owner:
Caf a Maoa ement Company,
Noma
280 Merrimack Street
Address(if different from location)
Methuen MA 0I844
Cuyifcwn 8�ua Zip Code
9786822382 u743
Telephone Number
B~ Pump~ng Record
10/3I/2024 lOO.00OO
1. Date ofPumping Date 2. Quantity Pumped: GaUonn
3. Component: [—lCeampoo|(e) Septic Tank [—lTi8htT�nk F�1 Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes MNo |f yes, was itcleaned? F-�Yes nNn
5. Observed condition cf component pumped-
Cover was accessed and properly o*ouzeu. 3 Bar Sink. l inches of grease on top. 6
ioobee of water. l inches of bottom sludge. 1.0 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Walls/bottom of trap in good condition.
System is at proper working level. Left O bottles of drain master. None. aoa Logs
Signed.
G. System Pumped By:
Joao Varela
Nume VooidoLimonsmmv�bor
RiverWind 6 Lizotte Drive, i I000 Marlborough., 01752
Company
7, Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd Taunton, MD 02780
I0/]l/2O24
Signature o,Hauler Ont*
eignetup*o[Raoeiving Facility(or attach facility receipt) Date
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