HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 152 ABBOTT STREET 2/25/2025 Commonwealth of Massachusetts
City/Town Of North Andover
System Pumping Record
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: Town of North Andover
152 Abbott Street
Address
North Andover MA 45
City/Town qt te MAR 4 2tXoe
2. System Owner:
David Johnson Health
Name
152 Abbott Street
..........
Adds_
-(if different from
North Andover MA 01845
City/Town State Zip Code
9787711027
Telephone Number
B. Pumping Record
1. Date of Pumping 0 2 2 5 2 0 2 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) Fj septic Tank R Tight Tank R Grease Trap
Other(describe):
Lift Station
...........
4. Effluent Tee Filter present? R Yes ' No If yes,was it cleaned? Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Lift Station system serviced. Filter not
present. Tank cannot be outfitted with filter. 1000 gallons removed. Light sludge
on bottom of tank. Light top solids in tank. Recommend further evaluation due to
tank levels. Main line is clear. Recommend Lift Station/Pump Repairs.
6. System Pumped By:
Jonathon Colson
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
Jonathon Colson 0 2/2 5/2 0 2 5
Signature-- of Hauler-— Date
Signature of Receiving Facility(or attach facility receipt) Date
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