HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 700 CHICKERING ROAD 6/24/2025 Commonwealth of Massachusetts
City/Town of North Andover
Iwo 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 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. Faci l ity 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 06/24/2025 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
r-] Other(describe):
4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes F1 No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
.present. Tank cannot be outfitted with filter. 1000 gallons removed. 3 inches of
bottom sludge. 1 inches of grease on top. 48 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Michael Graham
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
Michael Graham 06/24/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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