HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 2324 TURNPIKE STREET 6/2/2026 TOW, of Noilh Atidover
IL N Commonwealth of Massachusetts JUL - 2 2026
City/TownOf North Andover
System Pumping Record
Form 4 Health Department
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
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:
-Turike ir Street
Address
North Andover MA 01845
Y n .........5C��w.
2. System Owner:
_Little Sprouts Early Education & Child Care OS Little-S routs/ Leger (N
——-------- .............
Name
40 Strawberry Hill Road
Address(if different from location)
Concord MA 01742
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City/Town State Zip Code
7814206943........................................................................................................................
Telephone Number
B. Pumping Record
0 6/02/2 02 6 2000.0000
1. Date of Pumping 2. Quantity Pumped:
DateGallons
3. Component: Cesspool(s) Septic Tank F]Tight Tank R Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes FXJ No If yes, was it Gleaned? n Yes F-] 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. 4 inches of top solids. 2 inches of bottom sludge. 2000
gallons removed. Filter not present. Tank cannot be outfitted, with filter. Septic system
serviced.
6. System Pumped By:
Robert Herrick
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Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboroug ,_._MA 01752
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
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Robert Herrick 06/02/2026
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ignature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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