HomeMy WebLinkAboutAshland Farm Grease Trap - Septic Pumping Slip - 700 CHICKERING ROAD 12/10/2025 Commonwealth of Massachusetts
City/TownOf North Andover
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. Facility Information
1. System Location:
700 Chickerin_q__Road —--------------------------- .......
Address
North Andover MA 01845
City/Town --State............ _ZIp C dg.........................
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
12/10/2025 1000.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank F7 Grease Trap
Other(describe):
4. Effluent Tee Filter present? n Yes nX No If yes, was it cleaned? n Yes n 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. 5 inches of
bottom sludge. 5 inches of grease on top. 20 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jaime Rivera
...........
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Greater Lawrence Sanitary District 240 Charles Street , North Andover, MA
............
Jaime Rivera 12/10/2025
............
Signature of Hauler Date
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-Signature of Receiving Facility(or attach facility receipt) Date
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