HomeMy WebLinkAboutLift Station - Septic Pumping Slip - 1450 Osgood Street 7/26/2026 (3) Commonwealth nfMassachusetts
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System Pumping�� Record
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Form 4
DEP has provided this form for use by local Boards ofHom|m th
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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 31DCMR15.351.
A. Facility Information
1. System Location:
1450 Ds d Street
Addremm
North Andover MA 01845
City[To°n
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2. System Owner:
Plumbing d i �I450 d Street (Amazon)
Nmme
75 Beaeazob Drive
Address(if different from location)
Bio bam MA 02043
City/Town State Zip Code
9783999849
Telephone Number
B. Pumping Record
07/26/2O26 2OOO.00OO
1 Date 2 Quantity` Date
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3. Component: Cesspool(s) n Septic Tank F-1 Tight Tank Grease Trap
yX� Other(describe): Litt Station
4. Effluent Tee Filter present? F-] Yes RXNo |f yes, was itcleaned? Yes RNo
5. Observed condition of component pumped:
Cover was accessed and properly meoozeu. Main line is clear. System is at proper working
level. 7 inches of top solids. « inches of bottom sludge. z000 gallons removed. Filter not
present. rank cannot be outfitted with filter. Lift Station system serviced.
0. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 �i �� Drive, Suite IOOO Marlborough, �� 01752
Company
7. Location where contents were disposed:
020D Yard: 163 Western Ave, Gloucester, MA 01930
Marcus Lark 07/26/2026
SiQnoturnofHau|er —Date---
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Signature of Receiving Facility(or attach facility receipt) Date