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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 54 SUMMER STREET 11/10/2025 Commonwealth of Massachusetts 0" 'f'V01V'4nd0Ver City/Town of North Andover System Pumping Record NOV 10 2025 Form 4 ', ,' 9950 DEP 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 T t f fth to determine the form=a I they use.The System Pumping Record must be submitted to the local Board of Health or o within 14 days from the pumping date in accordance with 310 CMR 15.351. ftgrtrnent A. Facility Information 1. System Location: 54 Summer Street ....... ............ ................... ........ ---------------------------------------- Address North Andover MA 01845 ....................... ........................... City/Town 3taLe Zip_. .——----- e gd........................... 2. System Owner: Kyle Gletow Name 54 Summer Street ..I---........... ............................................................................................................... ............................................... ................................. Address(if different from location) North Andover MA 01845 City/Town State Zip Code 6176715254 Telephone Number B. Pumping Record 10/15/2025 �................. -1-5�-0 0.0 0 0.0................... 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Component: cesspool(s) ® septic Tank ❑Tight Tank Grease Trap © Other(describe): 4. Effluient Tee Filter present? Yes No If yes, was it cleaned? R Yes F-1 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 —--------------------------------------- ---e--hce Lice nse--'e Number ----------------V 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 10/15/2025 -------------------- .. ...............----—---------------------------...............-...........................------------------------------ Signature of Hauler Date ............................... ............ ............................... ............................................------- Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc-11/12 System Pumping Record-Page 1 of 1