HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 67 RALEIGH TAVERN LANE 11/17/2025 LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation TO"M 01 North Andover
Important:When Darrell Hamann
filling out forms -Owner
-
on the computer,
use only the tab 67 Raleigh Tavern Lane O 2025
key to move your Facility Street Address
cursor-do not North Andover 01845
use the return --—------ -------
key. City Zip Heaftj� epartment
VQ Mailing address of owner, if different:
Street Address/PO Box:
............ ......................................................................................................................................................
City State Zip
ext.
Telephone Number
B. Authorized Service Provider
Clear Water Industries
O&M Firm
P.O. Box 825
Street Address
Ipswich MA 01938
City State Zip
(978)356 -0779 ext.
Telephone Number
Christopher Maskell 19580
.............---------------------------------------- -------------------------
Certified Operator Name Certification Number
C. Facility/System Information
bE_P ob Manufacturer ID Model Number
Tnsta1Fa_tionbate____ Stark of Operation
Approval Type: F-1 General 171 Provisional F Piloting Z Remedial
Seasonal Residence—used less than 6 mo./year: F-1 Yes Z No
D. Operating Information
October 30, 2025 December 20, 2024
Inspection-Date Previous Inspection Date
Sludge Depth(to be checked yearly)
Pumping Recommended ❑ Yes Z No
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