HomeMy WebLinkAboutSeptic Pumping Slip - Starbucks - 419 Andover - 10/01/24 - Septic Pumping Slip - 419 ANDOVER STREET 10/1/2024 Cn[D0UoDVVea||h ofMassachusetts
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~�/�v / uxv// =F 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 310CMR15.351.
A. Facility Information
1. System Location:
419 Andover,
Address
North Andover MA 01845
2. System Owner:
Starbncka
Name
85 Wells Avenue, Suite llO
-Xd-d—ress—(if—d rent from location)
0 02459
City/Town State Zip Code
5O8A7758O6
Telephone Number
B. Pumping Record
I0/0I/2024 lDO DOOO
1. Date ofPumping 2. Quantity Pumped: '
uo� � Gallons
3. Component [—lCesspoo|(s) Fj septic Tank F-7 Tight Tank FXq Grease Trap
| | {)thmr(deachbe):
4. Effluent Tee Filter present? F—|Yes FXqNo |f yes, was itcleaned? F—1 Yes r—] No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Kitchen. g ioubea of grease on tog. 12
ioubee of water. 4 ioobea of bottom sludge. 35 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Grease trap needs 2 bolts replaced.
Walls/bottom of trap in good condition. System is at proper working level. Left O
bottles of drain master. One bolt would not come out. Recommend New Cover. Change
G. System Pumped By:
ZG AnthonyTrabucco
Nume Vehicle License Numu*r
Wind Riveri 6 Lizotte
Company
7. Location where contents were disposed:
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
IG Anthony Tzabuoou I0/01/2024
Sign�m"enfHav|nr Date
Sisnomn,o/Receiving Facility(or attach facility receipt) oo»e
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