HomeMy WebLinkAboutSeptic Pumping Slip - 1187 Salem St - 11/01/2024 - Septic Pumping Slip - 1187 SALEM STREET 11/1/2024 Commonwealth of Massachusetts
City/"rown0f 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:
1187 Salem Street
Address
North Andover MA 01845
City/Town Zip Code
2. System Owner:
Donna Hurlburt
Name
1187 Salem Street
Address(if different from—location.
North Andover MA 01845
City/Town State Zip Code
9788570678
Telephone Number
B. Pumping Record
11/01/2024 1500.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: Cesspool(s) RX Septic Tank F]Tight Tank R Grease Trap
F� Other(describe):
4. Effluent Tee Filter present? F-1 Yes Q No If yes, was it cleaned? F]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. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Unable to test main line. Recommend using boost
next pumping. Adding treatment between now and then will improve the health of
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, P18� 01752
Company -
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Robert Herrick 11/0 1/2 0 2 4
-Signature of Hauler Date
Signature—of Receiving Facility—(or attach facility receipt) Date ——-----------
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