HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 336 SHARPNERS POND ROAD 3/23/2026 dO
Commonwealth of Massachusetts TO f
Ver
City/Town0f North Andover APR 14
2026
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but thhi &a@,49"�qq be
substantially
ubstantially the same as that provided here.Before using this form,check with your local Board of Healih"to d ' t
they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within"14ht
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
-3.336 S.ha.rpners Pond Road
Address--'- _ .............................. .......................
North Andover MA 01845
............. ............
--
City!rown t t -zjp ;A-0——--------
2. System Owner:
Kaelyn Sackett - EEjmary ..............
Name
336 Sharpners Pond Road
Address(if different from location)
North Andover MA 01845
City/T own ------ State --- -Zip Code
5124361576
Telephone Number
B. Pumping Record
1500.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
..........
4. Effluent Tee Filter present? nX Yes n No If yes,was it cleaned? Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Recommend using boost next pumping. Adding
treatment between now and then will improve the health of your system. Please visit
www.bookmysepti.c.com to purchase online. Unable to test main line. Both baffles/tees are
intact. System is at proper working level. Light top solids in tank. Light sludge on bottom
of tank. 1500 gallons removed. Filter is present and was cleaned. Septic system serviced.
6. System Pumped By:
Jonathon Colson
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
Jonathon Colson 03/23/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc-11/12 System Pumping Record-Page 1 of 1