HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 980 OSGOOD STREET 4/3/2025 Town of Wh Andover
Commonwealth of Massachusetts
City/TownOf North Andover APR - 3 2025
System Pumping Record
Form 4 tment
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DEP has provided this form for use by local Boards of Health.Other forms may be used, rmai e sqt
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:
Avenue
Address
North Andover MA 01845
.dii t te
2. System Owner:
Vixxo — Various
Name
10 Columbus Boulevard 4th Floor
Address(iff different from location)
Hartford CT 06106
City/Town State Zip Code
5089875322
Telephone Number
B. Pumping Record
03/24/2025 2000.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: Cesspool(s) N Septic Tank F]Tight Tank n Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? n 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. 3000 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:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
............................... ..................
Paul Mentor 0 3/2 4/2 0 2 5
Signature of-Hauler
.............
Signature of Receiving Facility(or attach facility receipt) Date
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