HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 267 OLD CART WAY 11/10/2025 Commonwealth of Massachusetts
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City/TownOf North Andover
System Pumping Record aver
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informaho�67Z rm '9041,'�substantially the same as that provided here.Before using this fo ,check with your local Board of Health to d e 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. nT
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A. Facility Information -_Pc_7rtMc)f7t
1. System Location:
267 Old Cart Way
....................................................................------------------------................................................ .................... ---------
Address
North Andover MA 01845
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City/Town
2. System Owner:
Lisa Reichlen
Name
267 Old Cart Way
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Address(if different from location)
North Andover MA 01845
City/Town _§ta_te ________ -Zip Code
6033611212
Telephone Number
B. Pumping Record
10/28/2025 1500.0000
1, D ....
ate of Pumping _.D.a t......e........................... 2. Quantity Pumped:
Gallons
3. Component: F-1 cesspool(s) FX-] septic Tank F-]Tight Tank F] Grease Trap
F-] Other(describe):
------------- -----------...............................................
4. Effluent Tee Filter present? F-1 Yes ® No If yes, was it cleaned? R 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. 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. Recommend
using boost next pumping.
6. System Pumped By:
Michael Graham
......................------------ .......... ------------------__..............................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough,, MA 01752
...........
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
____.......... ............................. ------------------------............................ .................................... .............
Michael Graham 10/28/2025
Signature of Hauler Date
......................................................................................................................................... -------------...........
Signature of Receiving Facility(or attach facility receipt) Date
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