HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 236 SUMMER STREET 11/10/2025 Commonwealth of Massachusetts
...s W City/TownOf North Andover rown Of
System Pumping Record
Form 4 L
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the in tion must be
form,
substantially the same as that provided here.Before using this check with your local Board omltqtgd r ine,the form
they use,The System Pumping Record must be submitted to the local Board of Health or other approving a Wivithin 14
days from the pumping date in accordance with 310 CMR 15.351
A. Facility Information Vepart/7,,,,t
1. System Location:
236 Summer Street,
Address
North Andover MA 01845
sty/ —------------------------
Town
2. System Owner:
Rob Wu
Name
236 Summer Street,
-----------
Address(if different from location)
North Andover_.--- ....__.-_.._.._.___......_.-----------..-.__. MA 0.1-8.4.5
City/Town State Zip Code
7817758029
Telephone Number
B. Pumping Record
1. Date of Pumping .10/31 2 02 1500.0000
2
Date . Quantity Pumped: -Gal.I.o-ns -----------------
3. Component: ❑ Cesspool(s) � septic Tank Tight Tank Grease Trap
F-1 Other(describe):
............ ..........
4. Effluent Tee Filter present? n Yes r7/1 No If yes, was it cleaned? Yes R No
1^1
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. 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.
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:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
................................--.-......------ ...................--------------------- ......................
Marcus Lark 10/31/2025
--.-.......... ......................................... --------------- .................
Signature of Hauler Date
..................................... ..........................................................
Signature of Receiving Facility(or attach facility receipt) Date
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