HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 10/14/2025 Commonwealth of Massachusetts
Z
CitY/Town0f 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 jetioeV,
they use.The System Pumping Record must be submitted to the local Board of Health or other approv" i in 14
days from the pumping date in accordance with 310 CMR 15.351. e
A. Facility Information
1. System Location:
757 Turnpike Street
Address
North Andover MA 01845
City/Town -------------
2. System Owner:
C&W Services/Stop & Shop
.............--......... ........................... .............
Name
117 Kendrick Street, Suite 250
)Address-(if different from location)
Needham Heights MA 02494
—------------------------ —----- Zip'—Cod-e.................
2032381235
Telephone Number
B. Pumping Record
09/11/2025 600.0000
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Component: Cesspool(s) R Septic Tank F]Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? R Yes RX No If yes,was it cleaned? F-1 Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Bakery. 4 inches of grease on top. 6
inches of water. 4 inches of bottom sludge. 50 gallons removed. Both baffles/tees
are intact. No gasket is present. Walls/bottom of trap in good condition. System
is at proper working level. Left 0 bottles of drain master. Deli 1. 4 inches of
grease on top, 4 inches of water. 4 inches of bottom sludge. 25 gallons removed.
6. System Pumped By:
Liam Brown
---------- _V--—License
Name -Vehicle
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlbo MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
..................
Raymond Saez 09/11/2025
.............
Signature of Hauler Date
-----------Signature of Receiving Facility(or attach facility receipt) Date
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