HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 8/27/2025 M Town Of North Andover
Commonwealth of Massachusetts
City/Town0f North Andover SEP 2025
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be usedH on must be
substantially the same as that provided here.Before using this form,check with your local Pown, 'o )us m
u itv wit
they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority wit got
days from the pumping date in accordance with 310 CHAR 15.351.
A. Facility Information
1. System Location:
..1264 Os�q..2od_ Street ................
Aclar-o"ss—
North Andover MA 01845
City/Town --
2. System Owner:
Starbucks
—--------------------------
85 Wells Avenue, Suite 110
........................--------- .........
Address(if different from location)
Newton Center MA .......... 02459
..........
City/Town State Zip Code
4133274959
.11111-111 11-1--l-.......... ................. .............
Telephone Number
B. Pumping Record
08/27/2025 200.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons ..........----------
3. Component: cesspool(s) F] septic Tank F]Tight Tank Grease Trap
F-1 Other(describe):
4. Effluent Tee Filter present? R Yes rX—] No If yes,was it cleaned? R Yes F-1 No
5. Observed condition of component pumped:
3 Bay Sink. 12 inches of grease on top. 45 inches of water. 18 inches of bottom
sludge. 100 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. 3 Bay Sink. 1 inches of grease on top. 6
inches of water. 1 inches of bottom sludge. 25 gallons removed. Both baffles/tees
6. System Pumped By:
Marvin Collado
'a------------- ----,—s --'--- '- r.................................................4am Vehicle UceneNumba
Wind River Environmental, 46 otte Liz Drive, Suite 1000, Marlborouqh, MA 01752
Company
------- ..............................................I................. ............ ..........
7. Location where contents were disposed:
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
----..................------ ....................
Marvin Collado 08/27/2025
-Sio-11-1 .......... .................... ------------------Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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