HomeMy WebLinkAboutPumping Slip - 700 Chickering - Septic Pumping Slip - 700 CHICKERING ROAD 9/12/2024 Commonwealth of Massachusetts
V
City/Town of worth Andover
_..... A 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 total 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:
700 Chickering Road
Address
North Andover MA 01845
CitylTown State Zia Code
2. System Owner:
Ashland Farm at North Andover
Name
700 Chickering Road
Address(if different from location)
North Andover MA 01845
CityrFown State Zip Code
9786831300
Telephone Number
B. Pumping Record
09/12/2024 100.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank � Grease Trap
❑ Other(describe):
4. Effluent Tee Filler present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Kitchen. 4 inches of grease on top. 1.0
inches of water. 4 inches of bottom sludge, 40 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Walls/bottom of trap are in need of
repair. Recommend Trap Repair/Replace, Unable to assess level of tank -- Recommend
plumbing evaluation. Left 0 bottles of drain master. 130H Logs Signed.
6. System Pumped By:
Thiago Domingos
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
Thiago Domingos 09/12/2024
Signature of Hauler to
Signature of Receiving Facility(or attach facility receipt) Date
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