HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 11/10/2025 IL Commonwealth of Massachusetts
1 City/TownOf North Andover
System Pumping Record
Form 4
9 5) 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 determine the 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: TOWn of No�h Andover
1 64 Os ood Street
Address
North Andover MA NOkJ40 2025
-stat --code-.._..._--_._...-_--_- -_stag-................. ...........
2. System Owner: 'i. DepartMent
Starbucks
Name
85 Wells Avenue, Suite 110
............ .................... ........................
................
Address
(if different from location)
Newton Center MA 02459
..........................
�ehj/fownn� State Zip Code
.-4.133274959
Telephone Number
B. Pumping Record
10/28/2025 200.0000
1. Date of Pumping .................... 2. Quantity Pumped:
DateGallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? R Yes RX No If yes, was it cleaned? R Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. 3 Bay Sink. 1 inches of grease on top. 12
inches of water. 1 inches of bottom sludge. 25 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Grease trap needs 1 bolt replaced.
Walls/bottom of trap in good condition. System is at proper working level.
Silicone applied to trap cover. Left 0 bottles of drain master. 3 Bay Sink. 12
6. System Pumped By:
Liam Brown
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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
... .............. ———----------------------------..................... ...I.... ................ ..........
Signature of Hauler Date
-Signature,- - -o-f R—ec,e-i"v,i-n--g",-F-"a--"c,-i"l,i-t"y-(-,or—attach,,-, f-ec'"i-ii-ty" re,receipt) -Date——-—------------------------ ............................
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