HomeMy WebLinkAboutPanera Grease Trap - Septic Pumping Slip - 58 PETERS STREET 11/10/2025 Commonwealth of Massachusetts 7bwn of"10*4ndover
City/TownOf North Andover Nov 10 2025
System Pumping Record
Form 4
DEP has provided this,form for use by local Boards of Health.Other forms may be used,but tk�'!'4"ihn a
substantially the same as that provided here.Before using this form,check with your local Board of Health to
they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority wit�hinU
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
58 Peters Street
Address
North Andover MA 01845
City/Town —--------------- ...... ...........................
2. System Owner:
PR Restaurants LLC / Panera Bread
Name
2150 Washington Street, Suite 125
Address(if different from location)
Newton Lower Falls MA ---...... 02462 ...................
City/Town State Zip Code
7746013210
------------
Telephone Number
B. Pumping Record
1. Date of Pumping 10/28/2025 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: F-] Cesspool(s) F] Septic Tank F-]Tight Tank FX-]Grease Trap
F*� Other(describe):
4. Effluent Tee Filter present? F] Yes No If yes, was it cleaned? n Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. 3 Bay Sink. 4 inches of grease on top. 6
inches of water. 4 inches of bottom sludge. 50 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Walls/bottom of trap in good condition.
System is not at proper working level. Recommend plumbing evaluation. Left 0
bottles of drain master. BOH Logs Signed. Recommend Drain Cleaning. Full running
6. System Pumped By:
Liam Brown
------------——-----------........ ------- ------ ................... .......-—--------.............
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
...........
Company
7. Location where contents were disposed:
Berwick Sewer District : 2 Power House Road, Berwick, ME 03901
Liam Brown 10/28/2025
Signature of Hauler Date
...................... ........................................ ................---.............................. ........................---...-
Signature
of Receiving Facility(or attach facility receipt) Date
t5form4.doc- 11/12 System Pumping Record-Page 1 of 1