HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 63 CROSSBOW LANE 5/29/2025 juaw-peda(] queaH
x Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record SZ�Z E Nnr
Form 4 DEP has provided this form for use by local Boards of Health.Other forms may be used,b i �0 uMOl
substantially the same as that provided here.Before using this form,check with your local h— mine the 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:
63 Crossbow Lane
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Edith Duffy
Name
63 Crossbow Lane
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
5083359182
Telephone Number
B. Pumping Record
1. Date of Pumping 05/29/2025 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: El Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑X Yes ❑ No If yes,was it cleaned? X❑Yes No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 1500 gallons removed. Moderate 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 05/29/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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