HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 224 SALEM STREET 12/10/2025 Commonwealth of Massachusetts
City/TownOf 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:
224 Salem Street
Address
North Andover MA 01845
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City/Town Slate .............. ZP-Cade ..........
2. System Owner:
Michael Collins
Name
224 Salem Street
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Address(if different from location)
North Andover MA 01845
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State Zip Code
9783759474
Telephone Number
B. Pumping Record
12/10/2025 1500.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) M\7 Septic Tank n Tight Tank F] Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? n Yes No If yes, was it cleaned? F]Yes n 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 Lizotte Drive, Suite 1000, Marlborough, MA 01752
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Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
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Marcus Lark 12/10/2025
Signature of Hauler Date
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Signature of Receiving Facility(or attach facility receipt) Date
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