HomeMy WebLinkAboutRubicon-Grease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 2/7/2025 Town of'VOfth AndOver
Commonwealth of Massachusetts MAR -4 2025
.0 City/Town0f North Andover
System Pumping Record
Form 4 Pailment
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 310 CMR 15.351.
A. Facility Information
1. System Location:
_23_Turnpike Road
..............
Address
North Andover MA 01845
&ty1—Tow—n--'
2. System Owner:
Rubicon
Name
125 Half Mile Road, Suite 201
Address(if different from
Red Bank NJ 07701
City/Town State Zip Code
7 3 2 2 7 5 3 4 3 4
Telephone Number
B. Pumping Record
1. Date of Pumping 02/07/2025 3000.0000
2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) F] septic Tank Tight Tank Q Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes 1��l No If yes, was it cleaned? F]Yes Ej No
VNI
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. 3000 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
iName........ --e"h--,i"c"l""eLicense_
cens Number,--Li--e -----,V
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough MA 01752
g
Company
7. Location where contents were disposed:
NEW Yard: 54 Knox Trail, Acton, MA 01720 ----- ..........
Jaime Rivera 0 2/0 7/2 0 2
Signature of Hauler Date
-Signature of--Receiving'Facility Date
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