HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 315 TURNPIKE STREET 3/5/2024 .
City/Town Of North Andover �P�d
System Pumping Record
Form 4n ,C a
DEP has provided this form for use by local Boards of Health.Other forms may be used,but th in%r&ation must be
substantially the same as that provided here.Before using this form,check with your local Bof Health to determinethe form
they use.The System Pumping Record must be submitted to the local Board of Health or other approving aut p ty iv in 14
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
315 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Casella Organics
Name
283 Smith Road
Address(if different from location)
Chateaugay NY 12920
City/Town State Zip Code
6032905835
Telephone Number
B. Pumping Record
1. Date of Pumping 02/01/2024 2 Quantity Pumped: 4074.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? ❑Yes 0 No If yes, was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
Not Applicable water level. Oin bottom sludge. Oin top solids. Main line Clear.
No filter is present on the tank; current tank is not designed to be used with a
filter. Cover(s) secured. No 3rd party paperwork filled.
6. System Pumped By:
Glenn Perry
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Vanguard Renewables - Rutland: 51 Muschopauge Road, Rutland, MA 01543
Glenn Perry 02/01/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc• 11112 System Pumping Record•Page 1 of 1
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Commonwealth of Massachusetts ��,�® '�P�
City/Town of North Andover
System Pumping Record 05 tioti�
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:
315 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Casella Organics
Name
283 Smith Road
Address(if different from location)
Chateaugay NY 12920
City/Town State Zip Code
6032905835
Telephone Number
B. Pumping Record
02/21/2024 4026.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: ❑ Cesspool(s) ❑ Septic Tank ❑Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? Yes 0 No If yes, was it cleaned? ❑Yes ❑ No
5. Observed condition of component pumped:
Not Applicable water level. 5in bottom sludge. 5in top solids. Outlet baffles are
intact. Main line Clear. No filter is present on the tank; current tank is not
designed to be used with a filter. Cover(s) secured. No 3rd party paperwork
filled.
6. System Pumped By:
John Brancaccio
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Vanguard Renewables - Located in Haverhill: 1058 Boston Road, Haverhill, MA
John Brancaccio 02/21/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1