HomeMy WebLinkAboutSeptic Pumping Slip - 315 Turnpike - Dunkin - 10/31/24 - Septic Pumping Slip - 315 TURNPIKE STREET 10/31/2024 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:
315 Turnpike Street
Address
North Andover MA 01845
City/Town —------------------
2. System Owner:
Cafua Management,_Compar-y,_LLC
........................................
Name
280 Merrimack Street
---- ........ ............ .......................
Address(if different from location)
Methuen MA 01844
City/Town State Zip Code
9786822382 x7 4 3
Telephone Number
B. Pumping Record
1100.0000
-. Date of Pumping 10/3 1 2 0 2 4 2. Quantity Pumped: 100.00-'0"0
--
Date -da—Ilons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? n Yes No If yes, was it cleaned? [—]Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Kitchen. 1 inches of grease on top. 8
inches of water. 1 inches of bottom sludge. 30 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. BOH Logs
Signed.
6. System Pumped By:
Joao Varela
- --- ................................... .............................—..............................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
.............. ............—................................ --——-----------------
10/31/2024
Signature-0—f Hauler Date
-Signature of Receiving' attach facility receipt) Date
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