HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 140 MILL ROAD 3/12/2025 Commonwealth of Massachusetts TOW' of North Andover
City/TownOf North Andover
System Pumping Record APR - 3 2025
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 1=it Ith to determine the form
t r 9f Zr
they use.The System Pumping Record must be submitted to the local Board of Healt J[ ip1 I
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
140 Mill Road
Address
North Andover MA 01845
2. System Owner:
Wanda Metcalf
..............
Name
140 Mill Road
Addrass(if different from
North Andover MA 01845
City/Town State Zip Code
6175843446
Telephone Number
B. Pumping Record
03/12/2025 1000.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: F-1 Cesspool(s) Septic Tank F]Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-] Yes o No If yes, was it cleaned? F-]Yes R 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.
Main line is clear. Please ship one case of windriver treatment to customer.
6. System Pumped By:
Jonathon Colson
-V"--e—h i-c-le 1-1c"License'Number----—-------------------------------------------------------------------------
Name
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborouqt, _.MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
..........
Jonathon Colson 0 3/12/2 0 2 5
6ne-t—ur-e-o-of-Hauler -bate
Signature of Receiving Facility(or attach facility receipt), Date
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