HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 67 STONECLEAVE ROAD 11/10/2025 Commonwealth of Massachusetts Town Of ivolv;4ndover City/Town0f North Andover
System Pumping Record Nov 10
Form 4 2025
DEP has provided this form for use by local Boards of Health.Other forms may be used,b14*=tlon must be
substantially the same as that provided here.Before using this form,check with your local Board Iftitermine the form
o a
they use.The System Pumping Record must be submitted to the local Board of Health or other approving a 4 t
days from the pumping date in accordance with 310 CMR 16.351. /7
A. Facility Information
1. System Location:
67 Stonecleave Road,
......................... ..............------................
Address
North Andover MA 01845
6-ty-fi-o'"wr------------------------------------------------------- —------ ------
2. System Owner:
Jaime Nieves
Name
67 Stonecleave Road,
Addrass(if e-re—nt-fro-m—lo-c'ation)
North Andover MA 01845
City/Town State Zip Code
4132504620 x
Telephone Number
B. Pumping Record
10/13/2025 1000.0000
1. Date of Pumping 2. Quantity Pumped: ...................
Date Gallons
3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap
r-] Other(describe):
4. Effluent Tee Filter present? R Yes FX-1 No If yes, was it cleaned? Fj Yes ❑ 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. 1000 gallons removed. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Unable to test main line. Recommend using boost
next pumping. Adding treatment between now and then will. improve the health of
6. System Pumped By:
Robert Herrick
,. .I-....................... ------------ ............ .............--...........---....................... .....................................................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
6o-m-p-an'y------------------- --..............-----------—
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
....................
Robert Herrick 10/13/2025
............................. ---------- ................
Signature of Hauler Date
signature- - '' '' of'Receiving' --"-Facility-(or-attach'facility' ' '- receipt)--" , Date
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