HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 8/27/2025 Commonwealth of Massachusetts Town of No�h Andover
City/TownOf North Andover SEP 16 2025
System Pumping Record
Form 4 Health
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the inP
substantially the same as that provided here.Before using this form,check with your local Board of Health to�ine to 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 Chickening Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Ashland Farm at North Andover
Name
700 Chickering Road�o c__
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786831300
Telephone Number
B. Pumping Record
1. Date of Pumping 08/27/2025 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) F-1 septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-]Yes FX-] No If yes,was it cleaned? F-]Yes R No
5. Observed condition of component pumped:
3 Bay Sink. 2 inches of grease on top. 6 inches of water. 2 inches of bottom
sludge. 40 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. BOH Logs Signed.
6. System Pumped By:
Gabriel Mckinney-Dias
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
08/27/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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