HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 781 FOREST STREET 11/10/2025 Commonwealth of Massachusetts T0�41n 'of N"th 4ndover
City/Town of ' North Andover NOV 10
System Pumping Record 2025
Form 4 t' i4n' ld W DP has provided this form for use by local Boards of Health.Other forms may be used,Bute
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substantially the same as that provided here.Before using this form,check with your local Board of Health t(
3 d they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority "14"t
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
781 Forest Street
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Address
North Andover MA 01845
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City/Yawnt.t ._---------_____.._..___..
2. System Owner:
David T a o
Name
781 Forest Street,
Address(if different from location)
North Andover MA 01845
...................
City/Town State Zip Code
9784904746
Telephone Number
B. Pumping Record
1. Date of Pumping 10 0 9 2 0 2 5 2. Quantity Pumped: 1000.0000
DateGallons
3. Component: F] cesspool(s) Septic Tank F] Tight Tank Grease Trap
F-1 Other(describe):
4. Effluent Tee Filter present? 0 Yes R No If yes, was it cleaned? QYes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 1000 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. Customer purchased a pre-paid repair item.
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
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Michael Graham 10/019/2025
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Signature of Hauler Date
Signature o of Receiving c"eivin-g- Facility(or atta---c'h-facility',-- ,receipt).............. ....Date......................
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