HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1024 TURNPIKE STREET 10/27/2025 To w n o dover
Commonwealth of Massachusetts
City/Town0f North Andover MAR 2 3 2026
System Pumping Record
Form 4 in Rnffilrtment
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the in ormatio
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:
1024 Turnpike Street ---------------
Address
North Andover MA 01845
City/Town State Zip_Code
-
2. System Owner:
Mark Fagan — Primary Home
Name
1024 Turnpike Street- - —-------- ---------
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9173713201
Telephone Number
B. Pumping Record
1. Date of Pumping 10/27/2025 _ 2. Quantity Pumped: 5 0 0-.-0 0 0 0
Date Gallons
3. Component: F] cesspool(s) Septic Tank F]Tight Tank n Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? n Yes No If yes, was it cleaned? n Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Recommend using boost next pumping. Main line is
clear. Both baffles/tees are intact. system is at proper working level. Moderate amount of
top solids in tank. Moderate sludge on bottom of tank. 1500 gallons removed. Filter not
present. Tank cannot be outfitted with filter. Septic system serviced.
6. System Pumped By:
Michael Graham
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
-KENO Yard: 163 Western Ave, Gloucester, MA 01930
Michael Graham 10/27/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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