HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 1801 TURNPIKE STREET 10/14/2025 Commonwealth of Massachusetts Town of Nc"'. Mover
City/Town0f North Andover
System Pumping Record OCT 14 2025
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be L n atio!"Y'
,M bA 4 I=
substantially the same as that provided here.Before using this form,checkj a . 04@46 dZ%Rte 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:
1801 Turn p A,ke Street
Address
North Andover MA 01845
City/Town" - .......... zip-CMI.Q. ......................
2. System Owner:
Direct Supply.......... ------- .................
Name
7301 West-Ch Champions
Way
................... ........... ...... ........
_kJinis-s- different from location)
Milwaukee WI 53223
...........
--------------
City/Town State Zip Code
7042820530
Telephone Number
B. Pumping Record
09/30/2025 1000.0000
1. Date of Pumping 2. Quantity Pumped: .............. .......
Date Gallons
3. Component: r] cesspool(s) Septic Tank n Tight Tank FXJ Grease Trap
Other(describe):
..............
4. Effluent Tee Filter present? n Yes FXJ No If yes, was it cleaned? n Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
present. Tank cannot be outfitted with filter. 1000 gallons removed. 2 inches of
bottom sludge. 4 inches of grease on top. 48 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Robert Herrick
...................... ........... ---------- ..................-..................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
- -...........
Robert Herrick 09/30/2025
Signature of-Hauler -date-
-Si—gnatL;re of Receiving—Facility(or attach facility—receipt) —Date'---
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