HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1801 TURNPIKE STREET 4/2/2025 Commonwealth of Massachusetts
w� City/Town of North Andover
s
System Pumping Record
Form 4
M� 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:
1801 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Direct Supply
Name
7301 West Champions Way
Address(if different from location)
Milwaukee WI 53223
City/Town State Zip Code
7042820530
Telephone Number
B. Pumping Record
1. Date of Pumping 04/02/2025 2. Quantity Pumped: 1000.0000
Date Gallons
3. Component: ❑ Cesspool(s) ❑ Septic Tank Tight Tank ❑X Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑X No If yes, was it cleaned? ❑ Yes ❑ 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. 1000 gallons removed. 2 inches of
bottom sludge. 3 inches of grease on top. 48 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
NEMO Yard: 54 Knox Trail, Acton, MA 01720
Robert Herrick 04/02/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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