HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1211 OSGOOD STREET 7/1/2025 Commonwealth of Massachusetts
City/TownOf 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
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:
1211 Oscfood Street
4jd--ress---
North Andover MA 01845
Cityrrown _mate— Zip Code
2. System Owner:
Apiehak Lots Of Eats
Name
1211 Osgood Street
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
2078078343
Telephone Number
B. Pumping Record
1 Date
. Date of Pumping 0 7 0 1 2 0 2 5 2. Quantity Pumped: 200.0000
3. Component: F-] cesspool(s) Septic Tank ❑Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? n Yes nX No If yes, was it cleaned? F1 Yes n No
5. Observed condition of component pumped:
3 Bay Sink. 6 inches of grease on top. 14 inches of water. 6 inches of bottom
sludge. 125 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
Marvin Collado 07/01/2025
-Signature of—Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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