HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 790 FOREST STREET 3/21/2025 Commonwealth of Massachusetts Town Of North Andover
City/TownOf North Andover
WSJ System Pumping Record
Form 4 APR - 3 2025
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
thay'us6.The System Pumping Record must be submitted to the local Board of Health or 14
days from the pumping date in accordance with 310 CMR 15.351, tJ C1ent
A. Facility Information
1. System Location:
790 Forest Street
Address
North Andover MA 01845
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2. System Owner:
Pam & Paul Guerrieo
------------------ ........
Name
790 Forest Street
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North Andover MA 01845
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City/Town State Zip Code
9786832404
Telephone Number
B. Pumping Record
1. Date of Pumping 0 3/2 1/2 0 2 5—____ 2. Quantity Pumped: 1000.0000.
Date Gallons
3. Component: F-1 cesspool(s) Septic Tank Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? 0 Yes No If yes,was it cleaned? [-I Yes F-1 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. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Main line is clear. Recommend using boost next
pumping. Adding treatment between now and then will improve the health of your
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
- ----dompany ----
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
Robert Herrick 03/21/2025
Signature of Hauler Date
-Signature of Receiving Facility(or attach facility-r'e-ce1-ptj'--'--"" Date
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