HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 740 FOREST STREET 8/12/2026 Town of Noth Andover
Commonwealth of Massachusetts
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,bH"t4aUe f 4-np to i determine nt
substantially the same as that provided here. Before using this form,check with your local Board of Health 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:
740 Forest Street
Address
North Andover MA 01845
- - ------...........................................
City/Town ...............
2. System Owner:
Andrew Barnum - Prima r-y..V .Home
................................ ................
Name
740 Forest Street
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Address(if different from location)
North Andover MA 01845
...... ............---------
City/Town State Zip Code
6194580024
Telephone Number
B. Pumping Record
08/12/2026 1500 .0000
1. Date of Pumping ---- 2. Quantity Pumped: .........
Date Gallons
3. Component: F-] Cesspool(s) FXJ septic Tank n Tight Tank n Grease Trap
F] Other(describe):
--—----------------------
4. Effluent Tee Filter present? n Yes nX No If yes,was it cleaned? n Yes n 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. Light sludge on bottom of tank. Light
top solids in tank. System is at proper working level. Both baffles/tees are intact. Main
line is clear.
6. System Pumped By:
Jonathon Colson
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
..........--------------
Company
7. Location where contents were disposed:
KENO Yard: 163 Western Ave, Gloucester, MA 01930
Jonathon Colson 08/12/2026
Signature of Hauler Date
-.-.................... --—--------------------—----------------- .........
Signature of Receiving Facility(or attach facility receipt) Date
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