HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 34 BOXFORD STREET 3/19/2025 Town offtd Commonwealth of Massachusetts Andover
City/Town Of North Andover
System Pumping Record APR 3 2025
Form 4
D�P has,provided this form for use by local Boards of Health.Other forms may b use ut t14 information must be
substantially the same as that provided here.Before using this form,check wit q r �Xflfty"45E%e the form
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they use.The System Pumping Record must be submitted to the local Board of Health or other ap ovirtgauthord within14
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
34 Boxford Street
Address
North Andover MA 01845
City/Town State ZID Code
2. System Owner:
Jim Savarino
Name
34 Boxford Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9788284129
Telephone Number
B. Pumping Record
1. Date of Pumping 03/19/2025 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: FI Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? []Yes RX No If yes, was it cleaned? F-1 Yes F] 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. 1500 gallons removed. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Unable to test main line. Customer purchased a pre-paid repair item.
6. System Pumped By:
Jonathon Colson—
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
Jonathon Colson 03/19/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt)_ Date
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