HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 131 CRICKET LANE 8/29/2025 <L '011101 NoM'I Andover
Commonwealth of Massachusetts
City/Town0f North Andover
System Pumping Record SEP 16 2025
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used, a=,abn must be
substantially the same as that provided here.Before using this form,check with your ate V 0
oMhe f
they use.The System Pumping Record must be submitted to the local Board of Health or other approving in
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
131 Crickett Lane
-Kidre -.......................................-------
ss
North Andover MA 01845
dk—yiToWW'---- '51ate---- -- ZO-Q-9-de.........
2. System Owner:
Rex Palela
------------.1 .----............ ........ --------
Name
131 Crickett Lane
Address(if different from location)
North Andover MA 01845
...............
City/Town State Zip Code
9788524163
...........................
Telephone Number
B. Pumping Record
08/29/2025 1500.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: F-1 cesspool(s) Septic Tank Tight Tank F-1 Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? FX-] Yes F-] No If yes, was it cleaned? Yes F] 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 10_00, Marlborough, ---MA 01752
Com-Company . ....... ....... ............................. --- ----......................
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
............................................................---...............................
Michael Graham 08/29/2025
Signature-,-o f-Hauler —--------- Date
--------------.............
Signature o-f--Re-cei—vin--g---F--`ac .
Facility(or attach facility receipt) Date
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