HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 37 STONECLEAVE ROAD 7/21/2026 Commonwealth pfMassachusetts
C nmf North Andover
System Pumping Record
Form 4
oep has provided this form for use by local Boards nf Health.Other forms may be used,but the information must be
substantially the same ms 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 31OCMR15.351.
A. Facility Information
1. System Location:
37 Stooecleave Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Keith Graham Primary Home
Name
37 Stooecleaxe Road
Address(if different from location)
North Andover , MA 01845
c|tyoowm State Zip Code
9782101746
Telephone Number
B. Pumping Record
07/21/2026 1000 0000
1. D�t�VfPumpinQ Date �. (�u�ntityPum�gd� '
lons-
3. Component: F—lCesmpVo|(s) Septic Tank F—|Tight Tank F—}Grease Trap
|L��
Other(describe):
_ ` '�
4. Effluent Tee Filter present? [—1 Yes No |f yes, was itcleaned? [—lYeeF-jNo
5. Observed condition of component pumped:
Cover was accessed and properly aeonceu. Septic system serviced. Filter not present. Tank
cannot be outfitted with filter. 1000 gallons removed. Light oloune on bottom of tank. Light
top solids in tank. System is at proper working level. Both baffles/tees are intact. Unable
to teat main line.
G. System Pumped By:
Jonathon Colson
Name Vehicle License Number
Wind River Environmental, 46 zizotte Drive, Suite 1000 Marlbozoo h nm 0I752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street North Andover, M&
Jonathon CmI000
07/2I/2O26
Signature of Hauler Date
Signature m Receiving Facility(or attach facility receipt) Date
t5mnn4doo`11/12 System Pumping Record~Page 1uf1