HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 74 WILLOW RIDGE ROAD 6/26/2026 Town of North Andover
�L\ Commonwealth of Massachusetts
City/Town of North Andover JUL - 2 2026
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,buJhqWatiQQP&rtMent
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine the form
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:
74 Willow Ridge Road
.................................. ....................
Address
North Andover MA 01845
2. System Owner:
Jason
n Rotchstein - Jason Rotchstein
. ...............�ama
............................... ..................................
74 Willow Ridge Road
...........................
Address(if different from location)
North Andover MA 01845
CityfTown state Zip Code
7816035712
Telephone Number
B. Pumping Record
06/26/2026 1500.0000
1. Date of Pumping -Dai................................----------- 2. Quantity Pumped:
e Gallons
3. Component: F] Cesspool(s) nX Septic Tank n Tight Tank n Grease Trap
Other(describe):
4. Effluent Tee Filter present? n Yes nX No If yes, was it cleaned? n Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. 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. 1500 gallons removed. Filter not present. Tank cannot be outfitted with
filter. Septic system serviced.
6. System Pumped By:
Marcus Lark
-4rn -'- ------- ---,-'- ---cn--,--- -----------------------------ae Vehicle 1ieieNumber
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough 01752
&�M--p'an"y— ......................
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
............. ---------- ................—
Marcus Lark 06/26/2026
Signature of Hauler -D-a-i-e
Signature of Receiving Facility(or attach facility receipt) Date
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