HomeMy WebLinkAboutAffinity Realty - Septic Pumping Slip - 1980 TURNPIKE STREET 1/29/2025 Commonwealth of Massachusetts To Wn Of Alorth 4 n do Ver
City/Town0f North Andover
5
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used a must be
local
Im i
substantially the same as that provided here.Before using this form,check with your �Board o a r o"the form
r
they use.The System Pumping Record must be submitted to the local Board of Health or other approving au on
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
1980 Turnpike Street
Address
North Andover MA 01845
City/Town
2. System Owner:
Affinity t�L Property_Rea � JapT ag ent�
—L _ . ...........
Name
63 Atlantic -Avenue —------- --------
Address(if different from location)
Boston MA 02110
City/Town State Zip Code
9786949399
Telephone Number
B. Pumping Record
01/29/2025 3500.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑Tight Tank R Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑Yes No If yes, was it cleaned? n Yes n 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. 3500 gallons removed. 4 inches of
bottom sludge. 3 inches of top solids. System is at proper working level. Both
baffles/tees are intact. Main line is clear. Recommend using boost next pumping.
Adding treatment between now and then will improve the health of your system.
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
KENO Yard: 163 Western Ave, Gloucester, MA 01930
Robert Herrick 01/29/2025
'Signature of Hauler Date
__._ Date.
ate'— ———------------------—
Signature of Receiving 1=acility(or attach facility receipt)
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