HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 6/10/2025 Commonwealth of Massachusetts
w� City/Town of North Andover
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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:
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 ❑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. 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
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