HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 7/1/2025 Commonwealth of Massachusetts rown Of
City/Town0f North Andover Olt
System Pumping Record dover
Form 4 A t/6
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 f Health to determine the form
they use.The System Pumping Record must be submitted to the local Board of Health or other1600&fh -ty within 14
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information /,t
1. System Location:
315 South Bradford Street
Address
North Andover MA 01845
City/Town -51atp— Zip Code
2. System Owner:
Michael Smolak Farms
Name
315 South Bradford,
Address(if different from location)
North Andover MA 01845
City/Town State Zip Code
9785002019 x
Telephone Number
B. Pumping Record
1. Date of Pumping 0 7 0 1 2 0 2 5 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank F-]Tight Tank Q Grease Trap
Other(describe):
4. Effluent Tee Filter present? [—]Yes RX No If yes, was it cleaned? F]Yes R No
5. Observed condition of component pumped:
3 Bay Sink. 3 inches of grease on top. 6 inches of water. 3 inches of bottom
sludge. 20 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, Marlborouqh, 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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