HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 54 TUCKER FARM ROAD 10/14/2025 01 t�olth NVIOW
Commonwealth of Massachusetts CC, 14 VIS
City/1-ownOf North Andover
artment
System Pumping Record Ith
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
1. System Location:
54 Tucker Farm Road
Address
North Andover MA 01845
Zit /fown — State Zip Code
2. System Owner:
Mike Mead
Name
54 Tucker Farm Road
Address(if different from location) ---
North Andover MA 01845
City/Town State Zip Code
7812492786
Telephone Number
B. Pumping Record
09/16/2025 1500.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: M Cesspool(s) Septic Tank F-1 Tight Tank ❑ Grease Trap
Other(describe):
4. Effluent Tee Filter present? n Yes No If yes, was it cleaned? F-1 Yes [—] 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. 1500 gallons removed. Light 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:
Marcus Lark
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 09/16/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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