HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 315 TURNPIKE STREET 5/7/2024 Commonwealth of Massachusetts
City/Town of 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 MP`l
1. System Location: �t eft
315 Turnpike Street �}�
Address Wit 1Lt i
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 04/11/2024 2. Quantity Pumped: 5000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑ Tight Tank ❑X 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. 999in bottom sludge. 999in top solids. Main line Not
Applicable . 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:
Robert Herrick
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
Robert Herrick 04/11/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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