HomeMy WebLinkAboutAshland Farm-Septic - Septic Pumping Slip - 700 CHICKERING ROAD 2/18/2025 Commonwealth of Massachusetts Town of North Andover
City/TownOf North Andover MAR 4 2025
System Pumping Record
Form 4 Heaft
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the iih"aftm
substantially the same as that provided here.Before using this form,check with your local Board of Health to detefthe 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 Chickerinq Road
Address
North Andover MA 01845
City/Town
2. System Owner:
Ashland Farm at North Andover
Name
700 Chickerinq Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786831300
Telephone Number
B. Pumping Record
02/18/2025 1000.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: F] Cesspool(s) r\77 septic Tank F-�Tight Tank ❑ Grease Trap
Other(describe):
4. Effluent Tee Filter present? R Yes nX No If yes, was it cleaned? R Yes R 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. 1000 gallons removed. 2 inches of
bottom sludge. 2 inches of grease on top. 2 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jaime Rivera
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
NEMO Yard: 54 Knox Trail, Acton, MA 01720
Jaime Rivera 0 2/18/2 0 2
Signature-WHauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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