HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 8/14/2025 0" 'f"O't"4ndOver
aL� Commonwealth of Massachusetts
City/TownOf North Andover SEP 16 2025
System Pumping Record
lleh
Form 4 c,7/tqc 7M
DEP hasprovided this form for use by local Boards of Health.Other forms may be used,but the information mustrt11P
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine the fo Ot
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 CM R 15.351.
A. Facility Information
1. System Location:
12.64 0 S-9.2 24 §treet -------------------------------- ..............................
Address
North Andover MA 01845
Cityrrown
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
08/14/2025 1500.0000
1. Date of Pumping ______ 2. Quantity Pumped:
DateGallons
3. Component: Cesspool(s) n Septic Tank F]Tight Tank nX Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? F]Yes No If yes, was it cleaned? n Yes n No
1^1
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter riot
present. Tank cannot be outfitted with filter. 1500 gallons removed. 8 inches of
bottom sludge. 8 inches of grease on top. 20 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jaime Rivera
-Name-—---------------------------- Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborou h, MA 01752
---------......... .......... ..................
Company
7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
-----------
Jaime Rivera 08/14/2025
. ..........-.-.............
Signature of Hauler Date
-----------------
ignature of Receiving Facility(or attach facility receipt) Date
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