HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1483 SALEM STREET 3/5/2026 Commonwealth of Massachusetts Town of Aridover
City/Town Of North Andover
APR 14 System Pumping Record Z026
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 It ff16%1TH4'61tVPere"rminPtPAorrn
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:
1483 Salem Street
Address
North Andover MA 01845
City/Town 2W.C.00
2. System Owner:
Hope Ralph - Primary e
Name
1483 Salem Street
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Address(if different from location)
North Andover MA 01845
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City/Town State Zip Code
7814249679
Telephone Number
B. Pumping Record
1. Date of Pumping 0 3 0 5 2 026 2. Quantity Pumped: 1500..009-0.........
Date Gallons
3. Component: F1 cesspool(s) Septic Tank n Tight Tank F-] Grease Trap
Other(describe):
4. Effluent Tee Filter present? R Yes nX No If yes, was it cleaned? R Yes n 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. Light top solids in tank. Light sludge on bottom of tank.
1,500 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 1.000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Ipswich WWTP: 21 Fowlers Lane, Ipswich , MA 01938
........................
Marcus Lark 03/05/2026
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Signature of Hauler Date
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Signature of Receiving Facility(or attach facility receipt) Date
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