HomeMy WebLinkAboutAshland Farm Grease Trap - Septic Pumping Slip - 700 CHICKERING ROAD 11/10/2025 71�
Commonwealth of Massachusetts UWj? of Alol � 12clovel.
City/Town North Andover NOV
102025
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
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substantially the same as that provided here.Before using this form,check with your local Board of Health to determnW44
they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 1Mt
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
700 Chickeriag Road
----------
Address
North Andover MA 01.845
....................
City/Town Stag---------------------------------------------
2. System Owner:
Ashland Farm at North Andover--,-.---.-....... ----------__.............. ............
Name
700 Chickering Road
....................................-------------- ................... ------._...._.__...........------------
Address .
(if different from location)
North Andover MA 01845
..........................______-------........... ......
Cityrrown State Zip Code
9786831300
Telephone Number
B. Pumping Record
10/22/2025 100.0000
1. Date of Pumping 2. Quantity Pumped: Gallons
......_......._......_..._._._._..—___--
Date
Ions
3. Component: F-] cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F]Yes nX No If yes, was it cleaned? Yes n No
5, Observed condition of component pumped:
3 Bay Sink. 3 inches of grease on top. 10 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 are in need of
repair. Recommend Trap Repair/Replace. System is at proper working level. Left 0
bottles of drain master. 16inches 50gallons
6. System Pumped By:
Robbie Hall
......................... ............ .............. ----------------1..................... ................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
............I ...... ............ .......................
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
.............................. .............
Robbie Hall 10/22/2025
............................. ........ ----------
Signature of Hauler Date
............._........... ---------
Signature of Receiving Facility(or attach facility receipt) Date
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