HomeMy WebLinkAboutSeptic Pumping Sliip - 21 Fuller Meadow Rd - 11/04/2024 - Septic Pumping Slip - 21 FULLER MEADOW ROAD 11/4/2024 Commonwealth of Massachusetts
City/Town0f 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:
21 Fuller Meadow Road
Address
-North Andover MA 01845
Cityrrown
2. System Owner:
William Kissel
Name
21 Fuller Meadow Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
617 3 3 5 2 0 9 3
Telephone Number
B. Pumping Record
1. Date of Pumping 11/04/2024 2. Quantity Pumped: .1500.0000
Date Gallons
3. Component: Cesspool(s) V\I Septic Tank F]Tight Tank R Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-1 Yes No If yes,was it cleaned? F]Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank cannot be outfitted with filter. 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
_i4a`me__________—--------- -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 11/04/2024
Signature of Hauler Date
Signature of Receiving Facility-(or aft--ac-h" facility receipt) Date
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