HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 66 SUNSET ROCK ROAD 8/13/2026 Commonwealth of Massachusetts Town of North Andover
City/TownOf North Andover SEP 2 2026
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but ttw@ft �4;,W
substantially,the same as that provided here.Before using this form,check with your local Board of Hea tM ent
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:
66 Sunset Rock Road,
Address
North Andover MA 01845
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CityfTown
2. System Owner:
Steve Mouzakis - Primary Home
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Name
66 Sunset Rock Road
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Address(if different from location)
North Andover MA 01845
City/Tawn State -Zip Code
9782732482
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Telephone Number
B. Pumping Record
08/13/2026 1500.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: Cesspool(s) RX Septic Tank F] Tight Tank R Grease Trap
R Other(describe):
4. Effluent Tee Filter present? F]Yes RX No If yes, was it cleaned? R YesFj 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
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlb ua�?ro h, MA 01752
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Company
7. Location where contents were disposed:
Ipswich WWTP: 21 Fowlers Lane, Ipswich , MA 01938
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Marcus Lark 08/13/2026
-Signature of Hauler D-ate
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Signature of Receiving Facility(or attach facility receipt) Date
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