HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 185 GREAT POND ROAD 7/13/2026 Commonwealth mfK8 Usef�
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North Andover
System Pumping Record
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
Form 4
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 within14
days from the pumping date in accordance with 3|OCMR15.351.
A. Facility Information
1. System Location:
I85 Great Pond Road
Address
North Andover MA 01045
City/Town State
2. System Owner:
T Woolfolb Primary Home
Name
185 Great Pond Road
Addnyem(if different from location)
North MA 01845
Ckyffpwn State Zip Code
9172245610
Telephone Number
B. Pumping Record
O7/l3/202� I500,0000
1. Date ofPunnping Da� 2. Quantity Pumped: Gallons
3. Component F—1 Cesspool(s) F�� Septic Tank F—1 Tight Tank F—� Grease Trap
Other(describe):
L_1 ` ''
�� �� �� Y 4. EOluentTee Filter present7L_JY*sk^1No |fyem. vvasitc|eanmd� L_| es [—�L_| No
5. Observed condition of component pumped:
Cover was aooeeaad and properly secured. Septic system serviced. Filter not present. Tank
oaoont be outfitted with filter. 1500 gallons removed' Light sludge no bottom of tank. Light
top solids in tank. System is at proper working level. Both baffles/tees are intact. Main
line i; clear.
6. System Pumped By:
Jonathon Colson
Name Vehicle License Number
Wind River Environmental, 46 Li otte Drive, Suite I000 Marlborough, M& 01752
Company
7. Location where contents were disposed:
NE0O Yazd; 163 Western Ave, Gloucester, MA 01930
Jonathon Colson
O7/I3/2O26
Signature ofHauler Date
Signetureof Receiving Facility(or attach facility receipt) Oobe
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