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HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 6/24/2025 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 700 Chickering Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Ashland Farm at North Andover Name 700 Chickering Road Address(if different from location) North Andover MA 01845 City/Town State Zip Code 9786831300 Telephone Number B. Pumping Record 1. Date of Pumping 06/24/2025 2. Quantity Pumped: 1000.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes F1 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. 3 inches of bottom sludge. 1 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: Michael Graham 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 Michael Graham 06/24/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 757 Turnpike Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: C&W Services/Stop & Shop Name 117 Kendrick Street, Suite 250 Address(if different from location) Needham Heights MA 02494 City/Town State Zip Code 2032381235 Telephone Number B. Pumping Record 1. Date of Pumping 06/18/2025 2. Quantity Pumped: 4000.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes FINo 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. 4000 gallons removed. 4 inches of bottom sludge. 1 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: Michael Graham Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: NENO Yard: 163 Western Ave, Gloucester, MA 01930 Michael Graham 06/18/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 757 Turnpike Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: C&W Services/Stop & Shop Name 117 Kendrick Street, Suite 250 Address(if different from location) Needham Heights MA 02494 City/Town State Zip Code 2032381235 Telephone Number B. Pumping Record 1. Date of Pumping 06/18/2025 2. Quantity Pumped: 4000.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes FINo 5. Observed condition of component pumped: Cover was accessed and properly secured. Grease Tank system serviced. Filter not .present. Tank can be outfitted with filter - Sold Onsite. 4000 gallons removed. 4 inches of bottom sludge. 1 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: NENO Yard: 163 Western Ave, Gloucester, MA 01930 Robert Herrick 06/18/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 93 Turnpike Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Rubicon Name 125 Half Mile Road, Suite 201 Address(if different from location) Red Bank NJ 07701 City/Town State Zip Code 7322753434 Telephone Number B. Pumping Record 1. Date of Pumping 06/04/2025 2. Quantity Pumped: 3000.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes FINo 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. 3 inches of bottom sludge. 3 inches of grease on top. 0 inches of water. System is at proper working level. Both baffles/tees are intact. Main line is clear. 6. System Pumped By: Paul Mentor Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: Greater Lawrence Sanitary District 240 Charles Street North Andover, MA Paul Mentor 06/04/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 305 Middleton Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Commonwealth Dept. DCR Northeast Region Name 25 Shattuck Street Address(if different from location) Lowell MA 01852 City/Town State Zip Code 9784657223 Telephone Number B. Pumping Record 1. Date of Pumping 06/06/2025 2. Quantity Pumped: 1000.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 1000 gallons removed. 2 inches of bottom sludge. 2 inches of top solids. System is at proper working level. Both baffles/tees are intact. Main line is clear. 6. System Pumped By: Marcus Lark Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 Marcus Lark 06/06/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 74 Willow Ridge Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Jason Rotchstein Name 74 Willow Ridge Road Address(if different from location) North Andover MA 01845 City/Town State Zip Code 7816035712 Telephone Number B. Pumping Record 1. Date of Pumping 06/05/2025 2. Quantity Pumped: 1500.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 1500 gallons removed. Moderate sludge on bottom of tank. Light top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. 6. System Pumped By: Marcus Lark Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 Marcus Lark 06/05/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 370 Candlestick Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Kenneth Delatorre Name 370 Candlestick Road Address(if different from location) North Andover MA 01845 City/Town State Zip Code 6177178634 Telephone Number B. Pumping Record 1. Date of Pumping 06/05/2025 2. Quantity Pumped: 1500.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 1500 gallons removed. Moderate sludge on bottom of tank. Heavy amount of top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. Recommend adding Treatment. Please visit www.bookmyseptic.com to purchase online. 6. System Pumped By: Marcus Lark Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 Marcus Lark 06/05/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 295 Candlestick Road, Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Sergey Bebenin Name 295 Candlestick Road, Address(if different from location) North Andover MA 01845 City/Town State Zip Code 6174290294 Telephone Number B. Pumping Record 1. Date of Pumping 06/10/2025 2. Quantity Pumped: 1500.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 1500 gallons removed. Moderate sludge on bottom of tank. Moderate amount of top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. Recommend adding Treatment. Please visit www.bookmyseptic.com to purchase online. 6. System Pumped By: Marcus Lark Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 Marcus Lark 06/10/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 37 Stonecleave Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Keith Graham Name 37 Stonecleave Road, Address(if different from location) North Andover MA 01845 City/Town State Zip Code 9782101746 Telephone Number B. Pumping Record 1. Date of Pumping 06/13/2025 2. Quantity Pumped: 1000.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 1000 gallons removed. Light sludge on bottom of tank. Light top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. Recommend adding Treatment. Please visit www.bookmyseptic.com to purchase online. 6. System Pumped By: Marcus Lark Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 Marcus Lark 06/13/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 638 Forest Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Steven and Stephanie Parkes Name 638 Forest Street Address(if different from location) North Andover MA 01845 City/Town State Zip Code 9782230960 Telephone Number B. Pumping Record 1. Date of Pumping 06/10/2025 2. Quantity Pumped: 1500.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 1500 gallons removed. Light sludge on bottom of tank. Moderate amount of top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. 6. System Pumped By: Marcus Lark Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 Marcus Lark 06/10/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 698 Middleton Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Commonwealth Dept. DCR Northeast Region Name 25 Shattuck Street Address(if different from location) Lowell MA 01852 City/Town State Zip Code 9784657223 Telephone Number B. Pumping Record 1. Date of Pumping 06/16/2025 2. Quantity Pumped: 2500.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 2500 gallons removed. 1 inches of bottom sludge. 1 inches of top solids. System is at proper working level. Both baffles/tees are intact. Main line is clear. Recommend using boost next pumping. Adding treatment between now and then will improve the health of your system. 6. System Pumped By: Jonathon Colson Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: NENO Yard: 163 Western Ave, Gloucester, MA 01930 Jonathon Colson 06/16/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 2324 Turnpike Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Little Sprouts Early Education & Child Care Name 40 Strawberry Hill Road Address(if different from location) Concord MA 01742 City/Town State Zip Code 7814206943 Telephone Number B. Pumping Record 1. Date of Pumping 06/14/2025 2. Quantity Pumped: 2000.0000 Date Gallons 3. Component: Cesspool(s) Z septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes Z No If yes, was it cleaned? Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. Septic system serviced. Filter not .present. Tank cannot be outfitted with filter. 2000 gallons removed. 3 inches of bottom sludge. 1 inches of top solids. System is at proper working level. Both baffles/tees are intact. Unable to test main line. 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: NENO Yard: 163 Western Ave, Gloucester, MA 01930 Robert Herrick 06/14/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 757 Turnpike Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: C&W Services/Stop & Shop Name 117 Kendrick Street, Suite 250 Address(if different from location) Needham Heights MA 02494 City/Town State Zip Code 2032381235 Telephone Number B. Pumping Record 1. Date of Pumping 06/10/2025 2. Quantity Pumped: 400.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes FINo 5. Observed condition of component pumped: Cover was accessed and properly secured. Bakery. 4 inches of grease on top. 7 . inches of water. 4 inches of bottom sludge. 50 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. Meat. 1 inches of grease on top. 14 inches of water. 1 inches of bottom sludge. 50 gallons 6. System Pumped By: Liam Brown Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: NECS Yard 34-1 Hatchett Hill Road Old Lyme, CT 06371 Liam Brown 06/10/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 93 Turnpike Road Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Rubicon Name 125 Half Mile Road, Suite 201 Address(if different from location) Red Bank NJ 07701 City/Town State Zip Code 7322753434 Telephone Number B. Pumping Record 1. Date of Pumping 06/11/2025 2. Quantity Pumped: 100.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes FINo 5. Observed condition of component pumped: 3 Bay Sink. 10 inches of grease on top. 14 inches of water. 10 inches of bottom . sludge. 50 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. Pumped one grease trap. BOH Logs Signed. 6. System Pumped By: Terrill Todman Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343 Terrill Todman 06/11/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover Iwo 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 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. Faci l ity Information 1 System Location: 1264 Osgood Street Address North Andover MA 01845 City/Town State Zip Code 2. System Owner: Starbucks Name 85 Wells Avenue, Suite 110 Address(if different from location) Newton Center MA 02459 City/Town State Zip Code 4133274959 Telephone Number B. Pumping Record 1. Date of Pumping 06/10/2025 2. Quantity Pumped: 200.0000 Date Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap r-] Other(describe): 4. Effluent Tee Filter present? �Yes rX-] No If yes, was it cleaned? n Yes F1 No 5. Observed condition of component pumped: Cover was accessed and properly secured. 3 Bay Sink. 1 inches of grease on top. 10 . inches of water. 1 inches of bottom sludge. 25 gallons removed. Both baffles/tees are intact. Gasket is in good condition. Grease trap needs 1 bolt replaced. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. 3 Bay Sink. 12 inches of grease on top. 36 inches of 6. System Pumped By: Liam Brown Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Company 7. Location where contents were disposed: Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720 Liam Brown 06/10/2025 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1