HomeMy WebLinkAboutStop & Shop Grease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 12/4/2025 IL Commonwealth of Massachusetts
City/Town0f North Andover
S 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 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:
757 Turnpike Street
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Address
North Andover MA 01845
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CityfTown
2. System Owner:
c/o Ahold Stop & ShoName
1385 Hancock Street
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Address
if different from location)
.2uin,gy-------- .................. --------------.................. MA. -- 02169
City/Town State Zip Code
7046338250
Telephone Number
B. Pumping Record
12/04/2025 4000.0000
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Component: F] cesspool(s) F] septic Tank R Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? n Yes FX-j No If yes,was it cleaned? F]Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
present. Tank cannot be outfitted with filter. 4000 gallons removed. 2 inches of
bottom sludge. 2 inches of grease on top. 48 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
6. System Pumped By:
Michael Graham
.................... ......
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboroug4,_,,MA 01752
Company
7. Location where contents were disposed:
KENO Yard: 163 Western Ave, Gloucester, MA 01930
12/04/2025
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Signature of HaulerDate
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Signature of Receiving Facility(or attach facility receipt) Date
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