HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 987 FOREST STREET 4/7/2025 Commonwealth of Massachusetts
w� City/Town of North Andover
s
System Pumping Record
Form 4
M� 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:
987 Forest Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Marylou Southwick
Name
987 Forest Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9782392596
Telephone Number
B. Pumping Record
1. Date of Pumping 04/08/2025 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑X Septic Tank Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank cannot be outfitted with filter. 1500 gallons removed. Moderate
sludge on bottom of tank. Light top solids in tank. System is at proper working
level. Main line is clear. Recommend using boost next pumping. Adding treatment
between now and then will improve the health of your system. Please visit
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 04/08/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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