HomeMy WebLinkAboutStarbucks-Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 1/31/2025 Commonwealth of Massachusetts To Wn Of North 4/7do Ver
FEB 2
City/Town Of North Andover 025
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms maybe used,but einformation Q substantially the same as that provided here.Before using this form,check with your local Board of Health to determine IthNeOnt
Hea
th
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 CIAR 15.351,
A. Facility Information
1. System Location:
1264 Osgood Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Starbucks
Name
85 Wells Avenue, Suite 110
Address(if different from location)
Newton Center MA 02459
City/Town State Zip Code
8007827282
Telephone Number
B. Pumping Record
1. Date of Pumping 01/31/2025 2. Quantity Pumped: 200.0000
Date Gallons
3. Component: Cesspool(s) F] septic Tank R Tight Tank FV--1 Grease Trap
PIN
F-] Other(describe):
4. Effluent Tee Filter present? D Yes FX-] No If yes, was it cleaned? F-]Yes No
5. Observed condition of component pumped:
3 Bay Sink. 0 inches of grease on top. 12 inches of water. 0 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 0 bottles of drain master. 3 Bay Sink. 20 inches of grease on top. 20
inches of water. 20 inches of bottom sludge. 100 gallons removed. Both
6. System Pumped By:
Joshua Melendy
-Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Inside Grease — NEMO Yard:-54 Knox Trail, Acton, MA 01720
Joshua Melendy 01/31/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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