HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 305 MIDDLETON STREET 6/16/2026 Town of NMh Andover
Commonwealth of Massachusetts
City/TownOf North Andover JUL - 2 2026
System,Pumping Record
Form 4 Heafti'l rJUggwent
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the in orma
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:
305 Middleton Road
Address
North Andover MA 01845
City/Town State ode e
2. System Owner:
Commonwealth Dept. DCR Northeast Region — Harold Parker State Forest
Name
25 Shattuck Street
)W—dress(if different from location)
Lowell MA
-
City/Town State Zip Code
9784657223
Telephone Number
B. Pumping Record
1. Date of Pumping 06/16/2026 1000.0000
2. Quantity Pumped:
Date Gallons
3. Component: ❑ cesspool(s) M\7 Septic Tank Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? []YesFX—] No If yes,was it cleaned? F]Yes [—] 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. 1000 gallons removed. 3 inches of bottom sludge. 1 inches of
top solids. System is at proper working level. Both baffles/tees are intact. Unable to test
main line.
6. System Pumped By:
Robert Herrick
iName-- Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough,
Company
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 0183-5----
Robert Herrick 06/16/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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