HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 315 TURNPIKE STREET 5/7/2025 Commonwealth of Massachusetts , "thAndover
City/Town Of North Andover JUN 32025
System Pumping Record
Form 4J� ¢�,
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the in �rl�Eatic
substantially the same as that provided here.Before using this form,check with your local Board of Health to MTP nf they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 1I,
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
315 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner: 4`
Cafua Management° Company, LLC
Name
280 Merrimack Street
Address(if different from location)
Methuen MA 01844
City/Town r State Zip Code
9786822382 x743
r Telephone Number
B. Pumping Record
1. Date of Pumping : 05/07/2025 2. Quantity Pumped: 100.0000
10 Date Gallons
3. Component: Cesspool(s) ❑ Septic Tank Tight Tank Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑Yes Z No If yes,was it cleaned? ❑Yes n No
5. Observed condition of component pumped:
3 Bay Sink. 1 inches of grease on top. 12 inches of water. 1 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
s 05/07/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc•11/12 System Pumping Record•Page 1 of 1