6 ELEANOR ROAD SYSTEM PUMPING RECORD 10-11-22 DECEIVED
< Commonwealth of Massachusetts DEC 0 8 2022
;. City/Town of Salem CITY OF SALEM
System Pumping Record BOARD OF HEALTH
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
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 310 CMR 15.351.
A. Facility Information
1. System Location:
6 Eleanor Road _
Address
Salem _ MA 01970
City/Town State Zip Code
2. System Owner:
Tom & Shannon Lambert
Name
6 Eleanor Road
Address(if different from location)
.Salem MA 01970
City/Town State Zip Code
9789980027 x
Telephone Number
B. Pumping Record
1. Date of Pumping 10/11/2022 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: EjCesspools) Fjy� Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes F.V-] No If yes,was it cleaned? Yes No
5. Observed condition of component pumped:
Sj,stem Operating F!ne Nc')rmal- water le'rel Moderate tQp solids Moderate bgttom
current tank is not esigned to be use wit a filter. Cover(s) secured. Pumpe
1000 gallons. Recommended No Recommendation.
6. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
10/11/2022
S 6nature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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