HomeMy WebLinkAboutSeptic Pumping Slip - 143 Pheasant Brook - 11/12/2024 - Septic Pumping Slip - 143 PHEASANT BROOK ROAD 11/12/2024 Commonwealth of Massachusetts
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:
143 Pheasant Brook Road
Address
North Andover MA 01845
City/Town
2. System Owner:
..Stephanie Lamarca ..........
Name
143 Pheasant Brook Road
Address(if rent from
North Andover MA 01845
City/Town State Zip Code
6173656912
Telephone Number
B. Pumping Record
1. Date of Pumping 11/12 2 02 4._____ 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) FX-]septic Tank F]Tight Tank Grease Trap
F-] Other(describe):
4. Effluent Tee Filter present? R Yes nX No If yes,was it cleaned? R Yes � 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. None.
6. System Pumped By:
Marcus Lark
V a
Name— -------- ........................... —__le c—1e L'i G e
nse 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
Marcus Lark 11/12/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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