HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 64 NORTH CROSS ROAD 3/17/2026 Commonwealth of Massachusetts J f
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City/Town0f North Andover
System Pumping Record APR 14 2026
Form 4
DEP has provided this form for use by local Boards of Health.Other forms m y used,but the Information must be
substantially the same as that provided here.Before using this form,checkXe@ hil,I!a'qfglyato�al., jq�dettrmine the form
they use.The System Pumping Record must be submitted to the local Board of Health or o heeldp*o T,44Q&y within 14
days from the pumping date in accordance with 310 GEAR 15.351.
A. Facility Information
1. System Location:
64 North Cross Road
....................
Address
North Andover MA 01845
City/Town
2. System Owner:
Patrick Wilver - Patrick Wilver
Name
64 North Cross Road
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Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9784602357
Telephone Number
B. Pumping Record
1. Date of Pumping 03/17/2026 1000.0000
-- 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? M Yes Q No If yes, was it cleaned? R Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Recommend adding Treatment. Please visit
www.bookmyseptic.com to purchase online. Main line is clear. Both baffles/tees are intact.
System is at proper working level. Moderate amount of top solids in tank. Moderate sludge on
bottom of tank. 1000 gallons removed. Filter not present. Tank cannot be outfitted with
filter. Septic system serviced.
6. System Pumped By:
Marcus Lark
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
KENO Yard: 163 Western Ave, Gloucester, MA 01930
..........
Marcus Lark 03/17/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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