HomeMy WebLinkAboutSeptic Pumping Slip - 143 Lacy St - 11/01/2024 - Septic Pumping Slip - 143 LACY STREET 11/1/2024 Commonwealth of Massachusetts
r,.A City/Town of 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:
1_4_34a Street
Address
North Andover MA 01845
City/Town State
2. System Owner:
St!eph O'Maho!ny"____.._.. ................. ——-----......-------
Name
143 La
cy
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
6175937917
Telephone Number
B. Pumping Record
11/01/2024 1500.0000
1. Date of Pumping Date ......... 2. Quantity Pumped: Gallons
3. Component: 0 Cesspool(s) M\7 Septic Tank �Tight Tank R Grease Trap
Other(describe):
4. Effluent Tee Filter present? L^l I`�7/1 Yes F] No If yes,was it cleaned? r1❑t^1__1 Yes No
No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 1500 gallons removed. Moderate sludge on bottom of tank. Moderate
amount of top solids in tank. System is at proper working level. Both baffles/tees
are intact. Main line is clear. Recommend adding Treatment. Please visit
www.bookmyseptic.com to purchase online. E.
6. System Pumped By:
Michael Graham
..........
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
Michael Graham 11/0 1/2 0 2 4
Signature of Hauler Date
-Signature_of Receiving Facility—(or attach facility receipt) Date
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