HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 224 SUMMER STREET 11/10/2025 Commonwealth of Massachusetts 'OR/i7
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City/TownOf North Andover I
System Pumping Record NOV 102025
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informs 14 t be
a a substantially the same as that provided here.Before using this form,check with your local Board of Health to0 form
noto they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority
days from the pumping date in accordance With 310 CMR 15.351.
A. Facility Information
1. System Location:
224 Summer Street
Address
North Andover MA 01845
.............. ........................................
City/Town c9de-.-
2. System Owner:
Chris Stad
Name
224 Summer Street
.............. .....................
Address(if different from location)
North Andover MA 01845
..............
City/Town State Zip Code
6179439251
...................................................................
Telephone Number
B. Pumping Record
10/24/2025 1500.0000
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Component: cesspool(s) 0Septic Tank Tight Tank Grease Trap
R Other(describe):
4. Effluent Tee Filter present? R Yes RX No If yes, was it cleaned? F]Yes R 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
adding Treatment. Please visit www.bookmyseptic.com to purchase online.
6. System Pumped By:
Marcus Lark
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Name Vehicle License Number
Wind River Environmental, 46
-- -- Lizot....t.e. Drive, Suite 10.0.0..-,.-.M.....a.....rlb....o....rouqh, MA 01752
Company
...............
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
----................. ........................... .....................................................
Marcus Lark 10/24/2025
.......................... ............................---------- ...........................----...... ....... ...........................................................
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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