HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1018 OSGOOD STREET 5/7/2025 ai '
Commonwealth of Massachusetts
City/Town of North Andover
System Pumping Record
Form 4
.DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
s 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:
1018 Osgood Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Cafua Management Company, LLC
Name
280 Merrimack Street
Address(if different from location)
Methuen MA 01844
City/Town State Zip Code
9786822382 x743
Telephone Number
B. Pumping Record
1. Date of Pumping 05/07/2025 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes M No If yes,was it cleaned? ❑Yes No
5. Observed condition of component pumped:
3 Bay Sink. 2 inches of grease on top. 10 inches of water. 2 inches of bottom
.sludge. 30 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:
Steven Dominguez
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
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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