HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 140 MILL ROAD 4/1/2026 Commonwealth of Massachusetts
-) City/TownOf North Andover
System Pumping Record
Form 4
5w 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:
140 Mill Road
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North Andover MA 01845
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2. System Owner:
Wanda Metcalf - Primary Home
................................... .............. ................
Name
1.40 Mill Road
Address(if different from location)
North Andover MA 01845
City/Town State
6175843446
Telephone Number
B. Pumping Record
04/01/2026 1500.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: E] Cesspool(s) RX Septic Tank n Tight Tank n Grease Trap
E] Other(describe):
4. Effluent Tee Filter present? YesFXj No If yes, was it cleaned? R Yes F-1 No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter riot present. Tank
cannot be outfitted with filter. 1500 gallons removed. Moderate sludge on bottom of tank.
Moderate amount of 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:
Lamont Thomas
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Name
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboropg ,,_,n_01752
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7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
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Lamont Thomas 04/01/2026
Signature
iinature of Hauler Date
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Signature of Receiving Facility(or attach facility receipt) Date
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