HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 419 ANDOVER STREET 11/10/2025 Commonwealth of Massachusetts
1 City/"rown0f North Andover .A_
System Pumping Record n of Noft " ;90 Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but" foj"j,(k&t be
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substantially the same as that provided here.Before using this form,check with your local Boar 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.
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A. Facility Information
1. System Location:
419 Andover
............... ............... -----------
Address
North Andover MA 01845
......................
City/Town .............
2. System Owner:
Starbucks
Name
85 Wells Avenue, Suite 110
.....................1........... ------....... ..........
Address(if different from location)
Newton Center MA 02459
City/Town State Zip Code
4133274959
Telephone Number
B. Pumping Record
10 2 3 2 0 2 5 100.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons.............
3. Component: ❑ Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
..........__......
4. Effluent Tee Filter present? n Yes nX No If yes,was it cleaned? n Yes n No
5. Observed condition of component pumped:
3 Bay Sink. 4 inches of grease on top. 12 inches of water. 4 inches of bottom
sludge. 25 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. BOH Logs
Signed. Pumped one grease trap.
6. System Pumped By:
Terrill Todman
..........................I........... ........................... ----------- ........................ ------- -----------------
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough.......MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
.............. .......... ........... ..................
Terrill Todman 10/23/2025
......................... ....................................... ...............
Signature of Hauler Date
................. ------ .......... ...............................___._..__.._......
Signature of Receiving Facility(or attach facility receipt) Date
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