HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 315 SOUTH BRADFORD STREET 12/31/2025 Commonwealth rfMassachusetts
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=�|Iy/ | C�VV[] .�. North Andover
System Pumping Record
Form 4
DEP has provided this fo �rmrumebyl000|BourdmoYHeah inf
ormation
substantially the same am 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 31UCMR15.351.
A. Facility Information
1. System Location:
3I5 South Bradford
Address
North Andover 2B\ 0I845
City/Town State
2. System Owner:
BmoIak Farms
Name
3l5 South Bradford
Ada
remm(if different from location)
North Andover M8 0I845
City/Town State Zip Code
9785002019
Telephone Number
B. Pumping �� �
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12/31/2025 I000-0000
1. Date VfPumping Data 2. Quantity Pumped: GmUnna
F F�� [—� F—1
�. Component: L_—1 j <����p��Kg) ��ptioT�nh Tight L_]Gnamee Trap
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Other(describe):
L_| ` '�
4. Effluent Tee Filter present? F—1 Yes y�� No |f yes, was dcleaned? n Yes nNn
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank cannot be outfitted with filter. I000 gallons removed. 3 iurbem of
bottom sludge. l inches of top solids. System is at proper working level. Both
baffles/tees are intact. Maio line is clear. Service septic system for demo,
M. System Pumped By:
Paul Thomas
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive Suite lOOO Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street North Andover, MA
Paul Thomas
l2/3I/2O25
Signature'xHauler Date
Signature m Receiving Facility(or attach facility receipt) Date
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