HomeMy WebLinkAboutLift Station - Septic Pumping Slip - 1450 Osgood Street 7/26/2026 Commonwealth of Massachusetts
City/Town0f North Andover
System Pumping Record
Form 4
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:
1 4_5-0-_O'S�go-od S1 .....................------------------ --------
Address
North Andover. MA 01845
............................. .......................----------
City/Town S
..........................
2. System Owner:
Sagamore Plumbing and Heating LLC _g q OS - L11450 os Street (Amazon)-�
Name
75 Research Drive
..............-------------------- ................ ------------
Address(if different from location)
..HJ,.nghaT MA 02043
---—----------------------------------City/Town State Zip Code
9783999849
—............-.1.......
Telephone Number
B. Pumping Record
07/26/2026 7000.0000
1. Date of Pumping -Date................. ------ 2. Quantity Pumped:
Gallons
3. Component: F] cesspool(s) n Septic Tank F-]Tight Tank n Grease Trap
Other(describe): Lift Station
-............. --................... ....................................... .............. ...........................................
4. Effluent Tee Filter present? n Yes ' No If yes, was it cleaned? F-]Yes F] No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Lift Station system serviced. Filter not present.
Tank cannot be outfitted with filter. 7000 gallons removed. 4 inches of bottom sludge. 1
inches of top solids. System is at proper working level. Both baffles/tees are intact. Main
line is clear.
6. System Pumped By:
Marcus Lark
.............................................. ........... ---------
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive,..........Suite- 1000, Marl.bor.o,u,cf,,h,,,.,,.,,,M,A.,-.01752
...............
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
.................
Marcus Lark 07/26/2026
.............
Signature of Hauler Date
................-..........................
Signature of Receiving Facility(or attach facility receipt) Date
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