HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 602 BOXFORD STREET 7/22/2026 Commonwealth of Massachusetts
City/TownOf 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:
602 Boxford Street
Address,
North Andover MA 01845
Cityrrown State......-----------.._........--......--------- Zip Code
2. System Owner:
Anna Si-nqh - Primary Home
Name
602 Boxford Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
8572228326
Telephone Number
B. Pumping Record
1. Date of Pumping 0 7/2 2/2 0 2 2. Quantity Pumped: 1500.0000
Date Gallons
3. Component: Cesspool(s) 0 Septic Tank Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? [—]Yes No If yes, was it cleaned? F-1 Yes F-] 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. 1500 gallons removed. Moderate sludge on bottom of tank.
Moderate amount of top solids in tank. System is at proper working level. Both baffles/tees
are intact. Main line is clear.
6. System Pumped By:
Marcus Lark
NameVehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
Marcus Lark 07/22/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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