HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 700 CHICKERING ROAD 7/1/2025 Commonwealth nfMassachusetts
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Form 4DEP has provided this form for use by local Boards of Health.Other forms may be us,4
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.'` the information must be
substantially'the same--that_provided_her-Before using this_form,check with_your---
W Ith to determine the form
they use.The System Pumping Record must_~~submitted~the local Board~Health~ ~._
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days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
700 Chi
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
aobIaod Farm at North Andover
wmmw
700 Chickering Road
Address(if different from location)
North Ma 01845
cityrTown State Zip Code
9786831300
Telephone Number
B. Pumping Record
07/OI/2O25 lOO.0000
1 Date 2 Quantity' ou� � � Gm|wnm
3. Component: Cesspool(s) F] septic Tank F]Tight Tank JX-�Grease Trap
Other(describe):
4. Effluent Tee Filter present? D Yes RXNo |f yes,was bcleaned? nYes F-] No
5. Observed condition of component pumped:
o oar Sink. 2 iuouee of grease on ton. zO inches of water. z ioouea of bottom
sludge. 50 gallons removed. Both baffles/tees are intact. Gasket is in bad
condition - Recommend replacing gasket. Walls/bottom of trap are in need of
repair. Recommend Trap Repair/Replace. System is at proper working level. Left 0
bottles of drain master. Pumped one grease trap. BOB Logs Signed.
G. System Pumped By:
Terrill Todmao
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, i IOOO lb b 01752
Company
7. Location where contents were disposed:
Holbrook wRE Yard: 24 South Street, Holbrook, MA 02343
Marvin CoIIado
O7/Ul/2O25
Signature orHauler ooxe
Signature o/Receiving Facility(or attach facility receipt) Date
/5fom4.uoo`11/12 System Pumping Record^Page 1ox1