HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 546 FOSTER STREET 10/14/2025 FivCommonwealth of Massachusetts Town Of ® , Andover
City/TownOf North Andover
System Pumping Record
Form 4 CT14 0'I
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the Informa iog ust 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 off"n pproving authority within 14
days from the pumping date In accordance with 310 CMR 15.351. VePartment
A. Facility Information
1. System Location:
546 Foster Street
. ...................... ............ ......-----------
Address
North Andover MA 01845
City/Town ................................ ....... .............
2. System Owner:
Deborah Moore
............. .................. ...............................................
Name
546 Foster Street
Address(if different from location)
North Andover MA 01845
.......... ..........................................
City/Town State Zip Code
9785027683
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Telephone Number
B. Pumping Record
09/15/2025 1000.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) Q Septic Tank F]Tight Tank F-1 Grease Trap
Other(describe):
............. ...................................
4. Effluent Tee Filter present? []Yes 0No If yes, was it cleaned? I--] 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. 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.
6. System Pumped By:
Marcus Lark
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Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
...........
Marcus Lark 0 9/15/2 0 2 5
ST,6�i;�6racvf-H,,1W---------------- --Date
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Signature of Receiving Facility(or attach facility receipt) Date
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