HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1085 OSGOOD STREET 10/10/2023 Commonwealth of Massachusetts
City/Town of North Andover
R' System Pumping Record OC
Form 4
'M 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:
1085 Osgood Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
ORZO Restaurant/Cafe Trattoria IG
Name
1085 Osgood Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9786866921
Telephone Number
B. Pumping Record
1. Date of Pumping 09/24/2023 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: ❑ Cesspool(s) Septic Tank ❑ Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes, was it cleaned? ❑Yes No
5. Observed condition of component pumped:
[3 Bay Sink] : . Good condition. 2" H2O. 8" SOL. 8" GRS. Gasket OK. BOH logs signed.
Extra Services : . Pumped and cleaned 1 plastic grease trap. Did you check in and
out? : Unchecked. No signature/store stamp.
6. System Pumped By:
Vilton Marques
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
09/24/2023
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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