HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 419 ANDOVER STREET 7/3/2025 Commonwealth of Massachusetts rOW17 011V
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System Pumping Record
Form 4 406
DEP has provided this form for use by local Boards of Health.Other forms may be used,but thp ipformation must la
tto determine the i substantially the same as that provided here.Before using this form,check with your local Bo.VLOM 04 m
they use.The System Pumping Record must be submitted to the local Board of Health or other app rity within 14
days from the pumping date in accordance with 310 CMR 15.351. 2%
A. Facility Information
1. System Location:
419 Andover
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 07/03/202S 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) F] septic Tank R Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? []Yes RX No If yes, was it cleaned? R Yes R No
5. Observed condition of component pumped:
3 Bay Sink. 7 inches of grease on top. 25 inches of water. 7 inches of bottom
sludge. 45 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.
None. BOH Logs Signed.
6. System Pumped By:
Marcus Spencer
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
Marcus Spencer 07/03/2025
Signature Date
Signature of Receiving Facility(or attach facility receipt) Date
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