HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 2324 TURNPIKE STREET 12/2/2025 It\ Commonwealth of Massachusetts
City/Town0f North Andover
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:
132j_Turnpike Street
.................
Address
North Andover MA 01845
City/Town
2. System Owner:
Little Sprouts Early Education & Child Care
Name
40 Strawberry Hill Road
Address(if different from location)
Concord MA 01742
City/Town State Zip Code
7814206943
Telephone Number
B. Pumping Record
12/02/2025 2000.0000
1. Date of Pumping Date .......... 2. Quantity Pumped: .Gallons
3. Component: F] Cesspool(s) RX Septic Tank F]Tight Tank F]Grease Trap
R Other(describe):
4. Effluent Tee Filter present? R Yes L2J r"�l No If yes, was it cleaned? R 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. 2000 gallons removed. 1 inches of
bottom sludge. 2 inches of top solids. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jonathon Colson
............ ..........
Name Vehicle License Number
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
Jonathon Colson 12/02/2025
...........
Signature of Hauler Date
-signature of Receiving Facility(or attach facility receipt) Date
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