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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 122 FARNUM STREET 5/4/2026 Commonwealth of Massachusetts Town C)f IVOrth Andover City/TownOf North Andover System Pumping Record JUN 18 2026 Form 4 DEP has provided this form for use by local Boards of Heafth.Other forms may be used,b' ation must be substantially the same as that provided here.Before using this form,check with your Bbt=6;it termine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information 1. System Location: 122 Farnum Street ...................--........................................................ ................... Address North Andover MA 01845 -&ky -Statue............ ZRADQ-0 2. System Owner: Brooke and Karl Arakelian - PriTar Home 1.22 Farnum Street ...................... Address(if different from location) North Andover MA 01845 State Zip Code 9787647538 Telephone Number B. Pumping Record 05/04/2026 1500.0000 1. Date of Pumping 2. Quantity Pumped: ....... Date Gallons 1 Component: Cesspool(s) Septic Tank Tight Tank Grease Trap © Other(describe): ............-..................................... ................. .......... 4. Effluent Tee Filter present? R Yes nX No If yes, was it cleaned? R Yes F-] No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not present. Tank cannot be outfitted with filter. 1500 gallons removed. Moderate sludge on bottom of tank. Moderate amount of top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. 6. System Pumped By: Michael Graham ............. ------ ------- ------------ ------- ....... ...... 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 ........... ............................................ ....... Michael Graham 05/04/2026 ................................... ............................ Signature of Hauler Date -,-.--.......................................... —............ ................. .............. Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc-11/12 System Pumping Record-Page 1 of 1