HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 305 MIDDLETON STREET 6/6/2025 Commonwealth of Massachusetts
City/Town of North Andover
Iwo 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. Faci l ity Information
1 System Location:
305 Middleton Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Commonwealth Dept. DCR Northeast Region
Name
25 Shattuck Street
Address(if different from location)
Lowell MA 01852
City/Town State Zip Code
9784657223
Telephone Number
B. Pumping Record
1. Date of Pumping 06/06/2025 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap
r-] Other(describe):
4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 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. 2 inches of
bottom sludge. 2 inches of top solids. 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:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Marcus Lark 06/06/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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