HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 980 FOREST STREET 10/14/2025 Commonwealth of Massachusetts
V City/TownOf North Andover
System Pumping Record
Form 4
M5�'J, DEEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine the 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 15351.
A. Facility Information
1. System Location:
980 Forest Street
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Address
North Andover MA 01845
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City/Town
2. System Owner:
Charles and Step
hanie Apperson
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Name
980 Forest Street
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Address(if different from location)
North Andover MA 01845
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City/Town State Zip Code
7577144040
Telephone Number
B. Pumping Record
10/14/2025 1500.0000
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1. Date of Pumping .......... 2Date . Quantity Pumped: Gallons
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3. Component: Cesspool(s) Septic Tank F]Tight Tank [—I Grease Trap
Other(describe):
4. Effluent Tee Filter present? RX Yes R No If yes, was it cleaned? Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present
and was cleaned. 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
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Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
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Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
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Michael Graham 10/14/2025
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Signature of Hauler
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Signature of Receiving Facility(or attach facility receipt) Date
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