HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 660 SHARPNERS POND ROAD 8/25/2025 �L\ Commonwealth of Massachusetts
City/-rown0f 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 TOwn Of Nfifth Andover
1. System Location:
_.6.§.q_Sharpeners_.Pond Road
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Address SFP)4q 2025
North Andover MA
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C€tylTawn
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2. System Owner: Health Department
Jacquie Kane
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Name
660 Sharpeners Pond Road
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Address(if different from location)
North Andover MA 01845
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Cityrrown State Zip Code
9787647840 ....................
Telephone Number
B. Pumping Record
08/25/2025 1500.0000
1_ Date of Pumping Date 2. Quantity Pumped: Gallons- . .................
3. Component: F1 Cesspool(s) Septic Tank F-]Tight Tank R Grease Trap
F-1 Other(describe):
4. Effluent Tee Filter present? D Yes nX No If yes, was it cleaned? F-]Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter riot
present. Tank cannot be outfitted with filter. 1.500 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. Recommend using boost next
pumping. Adding treatment between now and then will improve the health of your
6. System Pumped By:
Robert Herrick
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Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlbg.r.2.u.gh. MA 0 1 75 2,
Company- " ............... - ------- ... .. ...-
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
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Robert Herrick 08/25/2025
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Signature of Hauler Date
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