HomeMy WebLinkAboutSeptic Pumping Slip - 1081 Osgood St - 10/02/2024 - Septic Pumping Slip - 1081 OSGOOD STREET 10/2/2024 Commonwealth of Massachusetts
C' nnf 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 n1DCmu15.3*1.
A. Facility Information
1. System Location:
1081 Osgood Street
Address
North Andover MA 0I845
City/Town State _Zip Code
2. System Owner:
LobsterTail**
Name
I081 Osgood Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6038905555
Telephone Number
B. Pu00p~ng Record
l0/O2/�O24 I0O.0000
1 Date 2 Quantity' oow ' � Ga|mne
3. Component [—lCesspool(s) F—1 septic Tank F—1 Tight Tank ��Groeee Trap
F—1 Other(dmecrbe):
4. Effluent Tee Filter present? [71 YesFX_jNo If yes, was itcleaned? r—]YesF� No
5. Observed condition uf component pumped:
Cover was accessed and properly secured. o Bay Sink. « iucuoo of grease on top. «
inches of water. 4 iocu*e of bottom sludge. ss 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. Boa Logs
Signed.
O. System Pumped By:
Raymond Saez
Name Vehicle License Number
Wind RiverEnvironmental, 46 Lizotte Drive, Suite 1000 Marlbaropq4, Ma 01752
Company
7. Location where contents were disposed:
Water-Solutions Group: 35 Mozzone Blvd Taunton, Ma 02780
Raymond Saeu I0/02/2024
Signature orHauler Date
eignammuf Receiving pomnty(v,eoacxfeoi|uymoaipt) Dam