HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 28 TUCKER FARM ROAD 8/28/2025 Commonwealth of Massachusetts down ,I North Andover
City/Town0f North Andover
SEP 16 2025
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be usdw- ,R!
substantially the same as that provided here.Before using this form,check with your local Board c Heal Mtoe MQat 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:
28 Tucker Farm Road
Address
North Andover MA 01845
Zkyfiyo;wn-------
2. System Owner:
David & Susan Saindon
.............. .............. ...............
Name
28 Tucker Farm Road
.............. .............................................-.----------
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
...
9783025113
........ .......................................... ..............................
Telephone Number
B. Pumping Record
08/28/2025 1500.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: ❑ Cesspool(s) 0 Septic Tank n Tight Tank F-1 Grease Trap
F-] Other(describe):
.................................................................
4. Effluent Tee Filter present? R Yes FX-] No If yes, was it cleaned? F]Yes [—] No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter not
present. Tank can be outfitted with filter - recommend 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. Unable to test main line.
Recommend using boost next pumping. Adding treatment between now and then will
6. System Pumped By:
Robert Herrick
.Name ........................................... ---e-hieLicense- -N-um`be Vic -r
Wind River Environmental, 46 Lizotte Drive, Suite 1.000, Marlb r ugh, MA 01752
Company .....................
7. Location where contents were disposed:
KENO Yard: 163 Western Ave, Gloucester, MA 01930
Robert Herrick 08/28/2025
Date
--—--------------
SignatureSignature of Hauler
of Receiving Facility(or attach facility receipt) Date
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