HomeMy WebLinkAboutSeptic Pumping Slip - 1018 Osgood - 10/31/24 - Septic Pumping Slip - 1018 OSGOOD STREET 10/31/2024 Commonwealth mJMassachusetts
��
~~|yV | um/|| °.nf
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 310CMn1a.os1.
A. Facility Information
1. System Location:
Address
North Andover MA 01845
City[Town
2. System Owner:
Caf a Ma a ement Company, LLC
Name
280 Merrimack Street
Address(if different from location)
Methuen MA 01844
City/Town State Zip Code
9786822382 u743
Telephone Number
B. Pumping Record
18/31/2024 100,0008
1. Date ofPumping Date2. Quantity Pumped: oa|Ion m
3. Component: [—lCesspool(s) [—1 septic Tank [—1 Tight Tank Grease Trap
| | [thmr(deeoribe):
4. Effluent Tee Filter pneoent7 [—1 Yes F�qNo |f yes, was itcleaned? F-7 Yes F—lNo
G. Observed condition of component pumped:
Cover was accessed and properly secured. 3 say Sink. 2 inches of gzcoae on top. 8
ioobea or water. 2 inches of bottom sludge. 20 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 0 bottles of drain master. None. Boa Loge
Signed.
G. System pumped By:
Joao Varela
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite I000 Ma lbo o b M& 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd Taunton, MA 02780
I0/3I/2O24
Signature ofHauler Date
Siqnomneof Receiving Facility(or attach facility receipt) oauo
t5fonn4.doc^11/12 System Pumping Record`Page 1 of