HomeMy WebLinkAboutStarbucks-Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 2/11/2025 Commonwealth of Massachusetts Town Of A!Orth 4ndover
City/TownOf North Andover 4 2025
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the in
0 0 substantially the same as that provided here.Before using this form,check with your local Board of Health to doter Vm 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 §.0 o�q Street__ --------------
Address
North Andover MA 01845
_6 _510--.
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
02/11/2025 1500.0000
1. Date of Pumping 2. Quantity Pumped: _da1ion_i_____
Date3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F]Yes No If yes,was it cleaned? E]Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
present. Tank cannot be outfitted with filter. 2000 gallons removed. 8 inches of
bottom sludge. 8 inches of grease on top. 8 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jaime Rivera
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, —Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
Jaime Rivera 02/11/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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