HomeMy WebLinkAboutPumping Record - Septic Pumping Slip - 980 OSGOOD STREET 1/23/2025 Commonwealth of Massachusetts Town of North Andover
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City/Town of North Andover 2025
System Pumping Record
Form 4 HeclIth
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information m
substantially the same as that provided here.Before using this form,check with your local Board of Health to d9et!rmainTA9Pt
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:
980 Osgood Avenue
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Vixxo - Various
Name
10 Columbus Boulevard 4th Floor
Address(if different from location)
Hartford CT 06106
City/Town State Zip Code
5089875322
Telephone Number
B. Pumping Record
1. Date of Pumping 01/23/2025 2. Quantity Pumped: 2000.0000
Date Gallons
3. Component: Cesspool(s) ful Septic Tank Tight Tank F]Grease Trap
Other(describe):
4. Effluent Tee Filter present? []Yes M 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. 2000 gallons removed. 1 inches of
bottom sludge. 1 inches of top solids. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped By:
Paul Mentor
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
Paul Mentor 01/23/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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