HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 2324 TURNPIKE STREET 6/14/2025 Commonwealth of Massachusetts
w� City/Town of North Andover
s
System Pumping Record
Form 4
M� 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:
2324 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Little Sprouts Early Education & Child Care
Name
40 Strawberry Hill Road
Address(if different from location)
Concord MA 01742
City/Town State Zip Code
7814206943
Telephone Number
B. Pumping Record
1. Date of Pumping 06/14/2025 2. Quantity Pumped: 2000.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑X Septic Tank Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X 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. 2000 gallons removed. 3 inches of
bottom sludge. 1 inches of top solids. System is at proper working level. Both
baffles/tees are intact. Unable to test main line.
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
Robert Herrick 06/14/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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