HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 315 SOUTH BRADFORD STREET 10/14/2025 Commonwealth of Massachusetts ro W/7 of'Vorth�n do ver
City/TownOf North Andover OCT 14 2025
System Pumping Record lyea/t� oe
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information rrpfvrn
us substantially the same as that provided here.Before using this form,check with your local Board of Health to determine thiqot
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:
315 South Bradford Street
Address
North Andover MA 01845
.............
City/ .Town
2. System Owner:
Smolak Farms
...........................
Name
315 South Bradford
Address(if different from
North Andover MA 01845
City/Town state Zip Code
9785002019
Telephone Number
B. Pumping Record
09/09/2025 1000.0000
..dWior
1. Date of Pumping 2. Quantity Pumped: oni----
3. Component: F-1 Cesspool(s) Septic Tank F]Tight Tank F]Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-]Yes RX No If yes,was it cleaned? F]Yes R 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. 1000 gallons removed. 24 inches of
bottom sludge. 24 inches of top solids. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jaime Rivera
a-ri .................. -------------------------- .............
Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlbor2u_gh, MA 01752
................ .........
Company
7. Location where contents were disposed:
NEMO Yard: 54 Knox Trail, Acton, MA 01720
............... ................ ....................---........................
Jaime Rivera 09/09/2025
-§6nature of Hauler Date
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-§I-in signature e""c--e-i,-v-i""n"-g"-F-,"a,-c,"il-i-t-y,(or—aftac—h facility- --` -r"eceipt-)- -D-aie— ...................................................................
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