HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 216 REA STREET 3/3/2026 Commonwealth of Massachusetts
w City/Town of North Andover
System Pumping Record
Form 4
GSM 'V
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
Important:When
filling out forms 1. System Location:
on the computer, 216 Rea Street
use only the tab
key to move your Address
cursor-do not North Andover MA 01845
use the return
key. City/Town State Zip Code
2. System Owner:
4t
Daniel Hooley
Name
216 Rea Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
978-681-7623
Telephone Number
B. Pumping Record
1. Date of Pumping 02/27/2026 2. Quantity Pumped: 1000
p g y p Date Gallons
3. Component: El Cesspool(s) E Septic Tank El Tight Tank El Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes E No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. System is at proper working
level. Both baffles/tees are intact.
6. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
02/27/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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