HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 57 COLONIAL AVENUE 5/29/2025 Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the Information must be
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine 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:
57 Colonial Avenue,
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Nitin Dhayaqude
Name
57 Colonial Avenue,
Address(if different from location)
North Andover MA 01845
Citylrown State Zip Code
9788091350
Telephone Number
B. Pumping Record
1. Date of Pumping 05/29/2025 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) ❑X Septic Tank ❑Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes 0 No If yes,was it cleaned? ❑Yes 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.
Both baffles/tees are intact. Main line is clear. Customer only wanted 1 case of
CCLS.
6. System Pumped By:
Lamont Thomas
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
Lamont Thomas 05/29/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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