HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 93 TURNPIKE STREET 2/10/2026 Commonwealth of Massachusetts Town m« /v0W} Andover
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System ��u����~n�� Record ~=` � ~ �~�~
Form 4
DEP has provided this form for use by local Boards o[Health.Other forms maybe
substantially the same mm�otpmvWad here.B�bmu�ngthis form,check wKhynml��|�6�hdo�fiatheform
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 510CMR15.351.
A. Facility Information
1. System Location:
93 Turnpike Road
*ovmso
North Andover MA 0I845
City/Town
2. System Owner:
Name
125 Half Mile Road Suite 201
Address(if different from location)
Red Bank 0J 0770I
City/Town State Zip Code
7322753424
Telephone Number
B. Pumping Record
O�/I0/2O26 lOU.00O8
1 Date 2 Quantity' Date � ' geUonn
3. Component: [—lCesspool(s) Septic Tank [—1 Tight Tank p��Grease Trap
| | Other(deecribe):
��
4. Effluent Tee Fikerpresent? L_JYes �� No If yes,was it cleaned? L_��`/] esL��
_| No
5. Observed condition of component pumped:
s Bay Sink. o inches of sceana on toe. o inches of water. s iuouea of bottom sludge. FOG so*.
ro gallons removed. Both baffles/tees are intact. Gasket is in ouou condition. walls/bottom
of trap in good condition. System is at proper working level. Left o bottles of drain master.
sos Logs Signed. Recommend Drain Cleaning. Do for preventive maintenance no nines and floor
drains
7-1nam tw.
0. System Pumped By:
Robbie Hall
Name Vehicle License Number
Wind Diver Environmental, 46 Lizotte Drive, Suite I000 Marlborough, MA 0I752
Company
7. Location where contents were disposed:
Inside Grease - 0EMO Yard: 54 Knox Trail, Acton, MA 01720
Robbie Hall
O2/l0/2O26
Signature ofHauler Date
Signature nf Receiving Facility(or attach facility receipt) Date
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