HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 81 CHRISTIAN WAY 4/21/2025 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:
81 Christian Way
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Jennifer Davis
Name
81 Christian Way
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9788854504
Telephone Number
B. Pumping Record
1. Date of Pumping 04/21/2025 2. Quantity Pumped: 1000.0000
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. 1000 gallons removed. Moderate
sludge on bottom of tank. Heavy amount of top solids in tank. System is at proper
working level. Both baffles/tees are intact. Main line is clear. Recommend adding
Treatment. Please visit www.bookmyseptic.com to purchase online.
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:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Marcus Lark 04/21/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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