HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 790 FOREST STREET 3/27/2026 I
Commonwealth of Massachusetts Town Of N'Orth, Andover
City/TownOf North Andover
System Pumping Record APR 14 2026
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,
substantially the same as that provided here.Before using this form,check with your local lo!Trofta' =4MOtom
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:
790 Forest Street
Address
North Andover MA 01845
-61t—yffo zip
2. System Owner:
Paul Guerrieo - PriT�a_ _Home
Name
790 Forest Street
---............................... .............
Address(if different from location)
North Andover MA 01845
i ------------------ ............... ----- ----
-- -
City/Town State Zip Code
6173205800
Telephone Number
B. Pumping Record
1. Date of Pumping .......__ 2. Quantity Pumped: -.10 0 0.0 0 0 0
Date Gallons
3. Component: Cesspool(s) FXJ septic Tank R Tight Tank R Grease Trap
F] Other(describe):
...........
4. Effluent Tee Filter present? R Yes 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, Marlbo h, MA 01752
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
Marcus Lark 03/27/2026
---------.........................................................................—----------------- ....................................... -.-------------------- .............................----....................................................
Signature of Hauler Date
............. .................... .................
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc-11/12 System Pumping Record-Page 1 of 1