HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 232 RALEIGH TAVERN LANE 5/11/2026 �L. Commonwealth of Massachusetts Town Of/Vo��)Andover
City/-rown0f North Andover JUN 18 2026
System Pumping Record
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DEP has provided this form for use by local Boards of Health.Other forms may be used,but the rape,,dater,
substantially the same as that provided here.Before using this form,check with your local Board of Health determine Wq4t
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:
2 3 2 Ralei c h Taver Lane............. ............. ........... —------
Address
North Andover MA 01845
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2. System Owner:
Bob Melillo - Primary Home
Name
232 Raleigh 'Paver Lane
.......... ..................................
Address(if different from location)
North Andover MA 01845
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City/Town State Zip Code
6.178727777
Telephone Number
B. Pumping Record
05/11/2026 1500.0000
1. Date of Pumping 2. Quantity Pumped: -Date Gallons
3. Component: Cesspool(s) RX Septic Tank R Tight Tank R Grease Trap
R Other(describe):
...............
4. Effluent Tee Filter present? R Yes RX No If yes, was it cleaned? R Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Recommend riser due to depth
of cover. Filter not present. Tank can be outfitted with filter - Sold Onsite. 1500 gallons
removed. Light sludge on bottom of tank. Moderate amount of top solids in tank. System is at
proper working level. Both baffles/tees are intact, Unable to test main line.
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 05/11/2026
.......... ------------.......... .................-------- ...............................
Signature of Hauler Date
............ ...... .........................................
Signature of Receiving Facility(or attach facility receipt) Date
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