HomeMy WebLinkAboutSmolak Farms-Grease Trap - Septic Pumping Slip - 315 SOUTH BRADFORD STREET 1/7/2025 Commonwealth nfMassachusetts Olt
C' n nf North Andover dober
System Pumping Record FES
Form 4 - 2025
DEP has provided this form for use by local Boards uf Health.Other forms may be used,but M' n must be
substantially the same mo that provided here.Before using this form,check with your local Boand6Y�6�� ine the form
they use.The System Pumping Record must be submitted to the local Board of Health or other approving
days from "617
A. Facility Information
1. System Location:
315 South Bradford Street
Address
North Andover Ma 01845
City/Town State io Code
3. System Owner:
Michael 8molab Farms
Name
315 South Bradford,
Address(if different from location)
North Andover M& 01845
City/Town State Zip Code
9785002019 u
Telephone Number
B. Pumping Record
01/07/2025 100.0000
1. OateofPumping Date2. C)uanUh/pumP�d� Gallons��
3. Component [—lCosaponKe) F-)septic Tank F-1 Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? []Yes RXNo |f yes,was dcleaned? 0 Yes RNo
5. Observed condition of component pumped:
s Bay Sink. * inches of grease on top. o inches of water. u inches of bottom
sludge. 35 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Left O bottles of drain master. Boo Logs Signed.
G. System Pumped By:
Raymond Saez
Name Vehicle License Number
Wind River Environmental, 46 Li otte Drive, Suite IOOO Marlborough, MA 0I752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd Taunton, M8 02780
Raymond Saez 01/07/2025
Signature ofHauler Date
Signature m Receiving Facility(or attach facility receipt) 000a
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