HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 141 REA STREET 4/3/2025 �I T
Commonwealth of Massachusetts Tbwq c,' Nofth Andover
City/TownOf North Andover APR -3 2025
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be�uko.�, kiqe in"
subl%q0al y the same as that provided here.Before using this form,check with your local Board'6�1==001the 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:
141 Rea Street
Address
North Andover MA 01845
2. System Owner:
William Perry
Name
141 Rea Street
.. - ..................... ............... ...........Address
;esi� .different from location)
North Andover MA 01845
....................... ........................... -.......................................
City/Town State Zip Code
9786188352
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Telephone Number
B. Pumping Record
03/26/2025 1000.0000
1. Date of Pumping -bate 2. Quantity Pumped: lions
3. Component: Cesspool(s) rXj septic Tank [—I Tight Tank R Grease Trap
R Other(describe):
4. Effluent Tee Filter present? R Yes FX] No If yes,was it cleaned? R 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.
Both baffles/tees are intact. Main line is clear. Recommend adding Treatment.
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6. System Pumped By:
Marcus Lark
............----------
ame 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 03/26/2025
-§i6r�a6r"e--of Hauler- Date
......
-s ..............
Signature of Receiving Facility(or attach facility receipt) Date
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