HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 1264 OSGOOD STREET 2/21/2025 Commonwealth of Massachusetts Town of art Andover
City/TownOf North Andover MAR 4 2025
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may b
substantially the same as that provided here.Before using this form,check with your local oar 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:
1264 Osgood Street
Address
North Andover MA 01845
City/Town -%ate— ------
2. System Owner:
S t a rb u c k s
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
02/21/2025 200.0000
1. Date of Pumping -6� 2. Quantity Pumped: -Gallons
3. Component: Cesspool(s) R Septic Tank Tight Tank FX-]Grease Trap
Fj Other(describe):
4. Effluent Tee Filter present? F]Yes o No If yes,was it cleaned? R Yes R No
5. Observed condition of component pumped:
3 Bay Sink. 6 inches of grease on top. 48 inches of water. 6 inches of bottom
sludge. 75 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. 2 inches of grease on top. 12
inches of water. 2 inches of bottom sludge. 25 gallons removed. Both baffles/tees
6. System Pumped By:
Marvin Collado
Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlr2p_qh,_MA 01752
Company
7. Location where contents were disposed:
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
Marvin Collado 02/21/2025
-Signature of-Hauler Date
Signatureof—Re—ceivinq Facility(or attach facility receipt) WW— Date
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