HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 160 CANDLESTICK ROAD 8/29/2025 Town of North Andover
�L\ Commonwealth of Massachusetts SEP 16 2025
19) City/TownOf North Andover
System Pumping Record Health Department
Form 4
W` 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 Systeril 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:
160 Candlestick Road
-Address...... ...................... ...... —-----
North Andover MA 01845
City/Town
2. System Owner:
Lee Salgado
......................... ..........
Name
160 Candlestick Road
Address(if different from location)
North Andover MA 01845
...........
Cityrrown State Zip Code
9786828711
.......... -------
Telephone Number
B. Pumping Record
1. Date of Pumping 08/29/2025 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Q Tight Tank F-]Grease Trap
Other(describe):
.......... ----------
4. Effluent Tee Filter present? []Yes No If yes,was it cleaned? F-]Yes F-] 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. 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
adding Treatment. Please visit www.bookmyseptic.com to purchase online.
6. System Pumped By:
Michael Graham
.............-------...... ......................... ..............
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
6'o'r pa n y- ------------------------ ...............................................
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
.............. ........ —----------............................................................................ ..........................
Michael Graham 08/29/2025
. ....................................—--- ---....... .................................
Signature of Hauler Date
-Signature of Receiving Facility(or attach facility receipt) Date
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