HomeMy WebLinkAboutAshland Farm Septic Tank - Septic Pumping Slip - 700 CHICKERING ROAD 6/16/2026 Town of North Andover
<L, Commonwealth of Massachusetts JUL - 2 2026
City/TownOf North Andover
System Pumping Record Heafth DepartMent
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 Chicktj�i�RR2Ad.......
Address
North Andover. MA 01845
City/Town State Zip Code
2. System Owner:
Ashland Farm at North Andover PL 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 06/16/2026 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: ❑ Cesspool(s) Q Septic Tank R Tight Tank F]Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-]Yes RX No If yes,was it cleaned? n YesF-] No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Both baffles/tees are intact. 4 gallons removed. 50
inches of bottom sludge. 10 inches of water. 4 inches of grease on top. FOG 84%. Kitchen.
Gasket is in good condition. Walls/bottom of trap are in need of repair. Recommend Trap
Repair/Replace. system is not at proper working level. Recommend plumbing evaluation. Left 0
bottles of drain master. BOH Logs Signed.
6. System Pumped By:
Kylen Grace
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborouqh, MA 01752
..........
Company
7. Location where contents were disposed:
Inside Grease
-.--- NE-MO Yard-:-54 Knox Trail, Acton, MA 01720
Kylen Grace 06/16/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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