HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 263 CANDLESTICK ROAD 11/10/2025 i2\- Commonwealth of Massachusetts
City/Town Of North Andover
4a System Pumping Record
Form 4
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 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 15.351.
A. Facility Information
1, System Location: of North Andover
263 Candlestick Road
Address
North Andover MA NO V i oqr5
City/Town State ZiD Code
2. System Owner:
d"I D e
Mary Nania Partment
Name
263 Candlestick Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9785182394
Telephone Number
B. Pumping Record
1. Date of Pumping 10/02/2025 1500.0000
2. Quantity Pumped:
Date Gallons
3. Component: El cesspool(s) Septic Tank F]Tight Tank F-]Grease Trap
F-] Other(describe):
4. Effluent Tee Filter present? F]Yes nX No If yes,was it cleaned? F-]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. Light sludge
on bottom of tank. Light top solids in tank. System is at proper working level.
Both baffles/tees are intact. Main line is clear. Recommend using boost next
pumping. Adding treatment between now and then will improve the health of your
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough., MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : ..-240 Charles Street , North Andover, MA
Robert Herrick 10/02/2025
.....-.......-
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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