HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 700 CHICKERING ROAD 4/7/2025 Commonwealth of Massachusetts
w� City/Town of North Andover
s
System Pumping Record
Form 4
M� 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:
700 Chickering Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Ashland Farm at North Andover
Name
700 Chickering Road
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786831300
Telephone Number
B. Pumping Record
1. Date of Pumping 04/07/2025 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑ Septic Tank Tight Tank ❑X Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
3 Bay Sink. 3 inches of grease on top. 8 inches of water. 3 inches of bottom
sludge. 50 gallons removed. Both baffles/tees are intact. Gasket is in bad
condition - Recommend replacing gasket. Walls/bottom of trap in good condition.
System is at proper working level. Left 0 bottles of drain master. Recommend
Drain Cleaning. Recommend Inside Grease Trap Replacement. HeBy rot, gasket and
6. System Pumped By:
Josh Melendy
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720
Josh Melendy 04/07/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc• 11/12 System Pumping Record•Page 1 of 1