HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 194 OLYMPIC LANE 4/3/2025 r< Town of North Andover
Z\- Commonwealth of Massachusetts
City/Town of North Andover
- 3
System Pumping Record APR 2025
Form 4
WIP has provided this form for use by local Boards of Health.Other forms may be us
substantially the same as that provided here.Before using this form,check with your hc =10==, VaLrn
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:
194 Olympic Lane
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Sarah & Ken Keogh
Name
194 Olympic Lane
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9785025535
Telephone Number
B. Pumping Record
1. Date of Pumping 03/19/2025 — 2. Quantity Pumped: 1000.0000.
Date Gallons
3. Component: Cesspool(s) Septic Tank Fj Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? [X-]Yes D No If yes, was it cleaned? LN"**/ Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 1000 gallons removed. Light sludge on bottom of tank. Moderate
amount of top solids in tank. System is at proper working level. Both baffles/tees
are intact. main line is clear.
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:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
Marcus Lark 03/19/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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