HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 645 SHARPNERS POND ROAD 10/23/2025 Commonwealth nfMassachusetts
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SystemPumping
Record
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Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informati* st be
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days from the pumping date in accordance with 310 CMR 15351,
A. Facility Information `-�'ePartrnellt
1. System Location:
645 Sharpners Pond Road
Address
North Andover M& 01845
City/Town State
2. System Owner:
Name
645 Sharpners Pond Road
Address(if different from location)
North Andover MA 0I845
City/Town State Zip Code
6178164451
Telephone Number
B. Pumping.n�� Record
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]0/23/2025 IUO0.000O
1 Date 2 Quantity' ��»a ' ' Gallons
3. Component: F—lceeapoo(a) Septic Tank F—1 Tight Tank F-7Grease Trap
| | Dther(desohbe):
4. Effluent Tee Filter present? F�q Yes [—lNo |f yes, was dcleaned? Yes F—lNn
S. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. zOOO 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 adding Treatment. Please visit
www.bookmyaeptio.com to purchase online.
G. 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:
Ipswich WWTP 21 Fowlers Lane, Ipswich MA 0I938
Marcus Lark 10/23/2025
Signature o[Hauler Oa\n
Signature of Receiving Facility(or attach facility receipt) Date
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