HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1265 SALEM STREET 4/14/2026 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:
1265 Salem Street,
Address
North Andover MA 01845
Cltyrrown _61fte
za-Coft........................
2. System Owner:
Allison Halleck - Primary Hoare ............................
Name
1265 Salem Street, -.------------.....................I.......................---------................ ...................................
Andress_(if d�fferenifrom location)
North Andover MA 01845
Cityrrown ................... State Zip Code
6172339903
..........._.'._.'______-------
Telephone Number
B. Pumping Record
04/14/2026 1000.0000
1. Date of Pumping ite 2. Quantity Pumped: 6_aH o-ni......................
3. Component: F] Cesspool(s) R] Septic Tank F] Tight Tank R Grease Trap
R Other(describe):
4. Effluent Tee Filter present? F]Yes RX 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. 1000 gallons removed. Light sludge on bottom of tank. Light
top solids in tank. System is at proper working level. Both baffles/tees are intact. Main
line is clear. Recommend using boost next pumping. Adding treatment between now and then
will improve the health of your system. Please visit www.bookmyseptic.com to purchase
online.
6. System Pumped By:
Jonathon Colson
.......... ...............
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboroug ...._MA 01752
............................
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
Jonathon Colson 04/14/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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