HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 207 BOXFORD STREET 6/6/2026 Town of North Andover
Commonwealth of Massachusetts JUL - 2 2026
City/Town0f North Andover
System Pumping Record
Healfilrb-
fm Form 4nent
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:
207 B o x f o r d Street,
Address
North Andover MA 01845
City/Town State -Z".Qd-O-------------
2. System Owner:
Lisa Winslow - Lisa Winslow
Name
207 Boxford Street
Address—(if different ir-om location}
North Andover MA 01845
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City/Town State Zip Code
9789303549
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Telephone Number
B. Pumping Record
06/06/2026 1500.0000
1. Date of Pumping mDate 2. Quantity Pumped: Gallons
3. Component: F1 Cesspool(s) Septic Tank Fj Tight Tank F Grease Trap
Other(describe):
4. Effluent Tee Filter present? FX Yes F No If yes, was it cleaned? Yes F No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Septic system serviced. Filter is present and was
cleaned. 1500 gallons removed. Light sludge on bottom of tank. Light top solids in tank.
System is at proper working level. Both baffles/tees are intact. Unable to test main line.
6. System Pumped By:
Robert Herrick
m.a Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
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Robert Herrick 06/06/2026
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Signature of Hauler Date
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Signature of Receiving Facility(or attach facility receipt) Date
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