HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 562 TURNPIKE STREET 11/10/2025 Commonwealth of Massachusetts Town of iVOrth Andover
City/TownOf North Andover
System Pumping Record
Form 4 'V0 V 10 2025
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 lt,��odetermine the form
they use.The System Pumping Record must be submitted to the local Board of Health or otterq6v' 14
days from the pumping date in accordance with 310 CMR 15.351. ent
A. Facility Information
1. System Location:
562
.-Jurn ipikt Street ....... -------------------
_—. --.-. .............. -------------
Address
North Andover MA 01845
City -Zip C d
a.................................
2. System Owner:
Starbucks
Name
85 Wells Avenue, Suite 1.10
------------- —--------............
Address(if different from location)
Newton Center MA 02459
.......... ................
CitylTown State Zip Code
4.133274959
Telephone Number
B. Pumping Record
101/23/2025 100.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons............................
3. Component: cesspool(s) 0 septic Tank n Tight Tank Q Grease Trap
Other(describe):
4. Effluent Tee Filter present? n YesFXj No If yes, was it cleaned? E]yes n No
5. Observed condition of component pumped:
3 Bay Sink. 4 inches of grease on top. 10 inches of water. 4 inches of bottom
sludge. 20 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. Silicone applied to trap cover. Left 0 bottles of drain master. BOO Logs
Signed. Pumped one grease trap.
6. System Pumped By:
Terrill Todman
---------- ............................................... .......................................... --------------
ame Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
-------------I.... ------Marlborough,
d6rnp-any
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd Taunton, MA 02780
........................ .......... ...............
Terrill Todman 10/23/2025
........................... ------.................. ............................ ......................
Signature of Hauler Date
-§.ig"n"a-,t-u-,r"-e--o-f—Re--c,-e,i-,v""i""n-",g","--F-"a,-c-i-li-t-"y(or attachf-a--c-ili,ty--r,-e-,c-,e,,i-p-t,-).............. b-a'-t
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