HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 980 OSGOOD STREET 2/17/2025 Commonwealth of Massachusetts
City/TownOf North Andover 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 MeMhormk=t 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 H a th or other approving authority within 14
days from the pumping date in accordance with 310 CMR 15.351. Partment
A. Facility Information
1. System Location:
980 Osgood Avenue
Address
North Andover MA 01845
-6i -—------------- ..........
ity/Town
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
02/17/2025 0.0000
1. Date of Pumping Gall
2. Quantity Pumped: —
Date ons
3. Component: F] Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? R Yes No If yes, was it cleaned? F-]Yes n No
5. Observed condition of component pumped:
Septic system serviced. Filter not present. Tank cannot be outfitted with filter.
0 gallons removed. 0 inches of bottom sludge. 0 inches of top solids. System is at
proper working level.. Main line is clear. Service date change as per customer no
access do to plowed snow.
6. System Pumped By:
Marcus Lark
-Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Marcus Lark 02/17/2025
Signature of—Ha,u--I-e,-r"--- Date
Signature of Receiving Facility(or attach facility receipt) Date
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