HomeMy WebLinkAboutSea Haven Lift Station - Septic Pumping Slip - 1450 Osgood Street 4/25/2026 IL Commonwealth of Massachusetts
City/Town0f North Andover
System Pumping Record
Form 4
195) 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 CHAR 15.351.
A. Facility Information
1. System Location:
1450 0S g o od Street ..............
Address
North Andover MA 01845
------—------------------ ......City/Tawn .-$late
2. System Owner:
Sea Haven Industries 00 Amazon Site: BOS3
............... ................
Name
710 Koehler Avenue
Address(if different from--—location)-
Ronkonkoma NY 11779
............ .............
Clty/Town State Zip Code
6317765102 xlll
Telephone Number
B. Pumping Record
04/25/2026 5000.0000
1. Date of Pumping 2Date . Quantity Pumped: Lallans
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
RX Other(describe): I,ift Station
..............
4. Effluent Tee Filter present? [:]Yes RX No If yes,was it cleaned? Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Lift Station system serviced. Filter not present.
Tank cannot be outfitted with filter. 5000 gallons removed. 12 inches of bottom sludge. 0
inches of top solids. System is at proper working level. Main line is clear.
6. System Pumped By:
Robert Herrick
..............................----.......................................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
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Company
7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
.............
Robert Herrick 04/25/2026
re of Hauler Date
-§716riaiu ................
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Signature of Receiving Facility(or attach facility receipt) Date
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