HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 70 RALEIGH TAVERN LANE 4/1/2026 Commonwealth of Massachusetts
City/TownOf North Andover
k IV System Pumping Record
Form 4�rrtl') 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:
70_Ra 1 e i gjjEAye�.rn Lane--....................................... ............. —-----
Address
North Andover MA 01845
City/Town -------
2. System Owner:
Walter Soule - Prim Home
............. ............. ...................
Name
70 Raleigh Tavern Lane 978-478-7888
............... --------------
-Address(if different from location)
North Andover MA 01845
.................. ..................
CitytTown State Zip Code
9784787888
Telephone Number
B. Pumping Record
04/01/2026 1500.0000
1. Date of Pumping ---------- 2. Quantity Pumped: .............Rate -deilions
3. Component: F] Cesspool(s) FASeptic Tank n Tight Tank ❑Grease Trap
R Other(describe):
4. Effluent Tee Filter present? FXI Yes No If yes, was it cleaned? [X-]Yes F] No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present and was
cleaned. 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.
No need to increase pumping. Yearly pumping with filter cleaning every 6 months.
6. System Pumped By:
Jonathon Colson
............................................ ................ ....................................... ....... ............
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company.River
............................................................. —------
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
...........................
Jonathon Colson 04/01/2026
................. .............................. ------------- ..........
Signature of Hauler Date
.....................--................. ........... .... .......--............ --------
Signature of Receiving Facility(or attach facility receipt) Date
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