HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 650 FOREST STREET 12/22/2025 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:
650 Forest Street
Address
North Andover MA 01845
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Cityrrown ate -zip Q.9
2. System Owner:
Drew Archer
Name
650 Forest Street
- ---.................----............ .......
Address(if different from location)
North Andover MA 01845
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City/Town State Zip Code
5083801229
Telephone Number
B. Pumping Record
12/22/2025 1500 .0000
1. Date of Pumping 2. Quantity Pumped: .............
DateGallons
3. Component: F] Cesspool(s) M\7 Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes M\/ No If yes, was it cleaned? F-1 Yes F] No
1^1
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
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company--'...............
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
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Marcus Lark 12/22/2025
Signature of Hauler Date
............
Signature of Receiving Facility(or attach facility receipt) Date
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