HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 35 MARIAN DRIVE 5/30/2025 Town ofIVorth An
Commonwealth of Massachusetts dovor
CitylTown of North Andover 3 2025
25
System Pumping Record
Form 4 Health D
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the inf rma!
substantially the same as that provided here.Before using this form,check with your local Board of Health to determR tnitorm
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:
35 Marian Drive
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Allison Ray
Name
35 Marian Drive >
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
6034012466
Telephone Number
B. Pumping Record
x
a 05/30/2025 1500.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: Cesspool(s) Septic Tank ❑Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? a Yes ❑ No If yes,was it cleaned? 0 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. Recommend using boost next pumping.
6. System Pumped By:
Michael Graham
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
Michael Graham 05/30/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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