HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 93 TURNPIKE STREET 2/27/2025 Commonwealth of Massachusetts
City/TownOf North Andover
System Pumping Record
Town of North Andover
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 otheMQoVrn4ajfij&y within 14
days from the pumping date In accordance with 310 CMR 15.351.
A. Facility Information
1. System Location: Health Department
_93 Turnpike Road
Address
North Andover MA 01845
City/Town
2. System Owner:
Rubicon
Name
125 Half Mile Road, Suite 201
Address(if different from location) ---—--------
Red Bank NJ 07701
Cityrrown State Zip Code
7322753434
.......
Telephone Number
B. Pumping Record
1. Date of Pumping 02/2 7/2 02 5—______ 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) F] septic Tank M Tight Tank a Grease Trap
F-1 Other(describe):
4. Effluent Tee Filter present? F-] Yes No If yes,was it cleaned? R Yes R No
5. Observed condition of component pumped:
3 Bay Sink. 3 inches of grease on top. 8 inches of water. 3 inches of bottom
sludge. 50 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Recommend increasing pumping frequency. Left 0 bottles of drain master.
Trap needs more frequent. BOH Logs Signed.
6. System Pumped By:
Joshua Melendy
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
Joshua Melendy 02/27/2025
-Signature of Hauler Date
Signature of Receiving Facility—(orattach—fa--cifity r-e- Date
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