HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 775 FOREST STREET 4/3/2026 Commonwealth of Massachusetts
City/TownOf North Andover
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Hearth.father 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:
775 Forest Street
Address
North Andover MA 01845
City/Town State------...__........_._....................._....
2. System Owner:
Erik Slivka - Prima��y__Home
.................. ------------ ---------
Name
775 Forest Street
'0�-if 61;an-Rro m-""-1 o--c-aiko .........................--------------
Address North Andover MA 01845
...........6-iiii own state ...................... -Zip Code .........
9788353412
Telephone Number
B. Pumping Record
04/03/2026 1500.0000
1. Date of Pumping 2. Quantity Pumped: --- .......
Date Gallons
3. Component: Cesspool(s) nX Septic Tank n Tight Tank Fj Grease Trap
n Other(describe):
4. Effluent Tee Filter present? n Yes nX No If yes, was it cleaned? n Yes 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. Light sludge on bottom of tank. Light
top solids in tank. System is at proper working level. Both baffles/tees are intact. Unable
to test main line. Recommend using boost next pumping. Adding treatment between now and
then will improve the health of your system. Please visit www.bookniyseptic.com to purchase
online. Recommend boost combo to maintain soilds and sludge. Can come back and add to tank.
6. System Pumped By:
Jonathon Colson
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough,�� h, MA 01752
...........
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
.......... ......... .................... ...... ..............
Jonathon Colson 04/03/2026
-. .......... ............... ................ ............... ..............
Signature of Hauler Date
.......................----.......
Signature of Receiving Facility(or attach facility receipt) Date
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