HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 55 PHEASANT BROOK ROAD 4/11/2025 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:
55 Pheasant Brook Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Pam Sullivan
Name
55 Pheasant Brook Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
3124984885
Telephone Number
B. Pumping Record
1. Date of Pumping 04/11/2025 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 can be outfitted with filter - recommend filter. 1500 gallons
removed. Light sludge on bottom of tank. Light top solids in tank. System is at
proper working level. Both baffles/tees are intact. Unable to test main line.
Recommend using boost next pumping. Adding treatment between now and then will
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Robert Herrick 04/11/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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