HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 535 CHICKERING ROAD 5/7/2025 t
_ Commonwealth of Massachusetts ®rthAndover
City/Town of North Andover JUN 3 2025
System Pumping Record
q
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the in or Doe
substantially the same as that provided here.Before using this form,check with your local Board of Health to d2te
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 Inform`ption
1. System Location: ;
535 Chickering Road
Address It
North Andover I MA 01845
City/rown State Zip Code
2. System Owner:
Cafua Management Company, LLC
Name
280 Merrimack Street
Address(if different from location)
Methuen MA 01844
Citylrown State Zip Code
9786822382 x743
Telephone Number
B. Pumping Record
1. Date of Pumping . 05/07/2025 2. Quantity Pumped: .0000
Date Gaallll ons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):it
4. Effluent Tee Filter present? Fj Yes � No If yes,was it cleaned? Yes No
5. Observed condition of component pumped:
3 Bay Sink. 1 inches of grease on top. 10 inches of water. 1 inches of bottom
,sludge. 15 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. BOH Logs Signed.
6. System Pumped By: e.
Steven Dominguez.
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company :I
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
05/07/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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