HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 255 FOREST STREET 11/10/2025 Commonwealth of Massachusetts To Wn rf'Vortl 4 n do ver
City/Town0f North Andover t
System Pumping Record
Form 4 NOV
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information'mu
substantially the same as that provided here.Before using this form,check with your loca oard of Health to determine the form
they use.The System Pumping Record must be submitted to the local Board of HealthgleatMvo authority within 14
days from the pumping date in accordance with 310 CMR 15.351. epc-jrtMz
A. Facility Information
1. System Location:
255 Forest Street
............................................
Address
North Andover MA 01845
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City/Town zjp-col-e.........
2. System Owner:
Elizabeth Wdow
Name
255 Forest Street
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Address(if different from location)
North Andover MA 01845
............................ ....................
City/Town State Zip Code
9787788977
Telephone Number
B. Pumping Record
10/29/2025 1000.0000
1. Date of Pumping ........................... 2. Quantity Pumped:
DateGallons
3. Component: FI Cesspool(s) Septic Tank Tight Tank Grease Trap
F] Other(describe):
.................-------.................................. ............
4. Effluent Tee Filter present? n Yes nX No If yes, was it cleaned? Yes n 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. 1.000 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 10/29/2025
-Signature of--Hauler. ate
Signature of ....................................................
Receiving F Date Reacility(or attach facility receipt) Dt
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