HomeMy WebLinkAboutPanera Bread Grease Trap - Septic Pumping Slip - 58 PETERS STREET 1/30/2026 Commonwealth of Massachusetts rb IMP ()
City/Town of North Andover
System Pumping Record FEB
Form 4 102026
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 au#"- #hin14
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 Zip Code
2. System Owner:
PR Restaurants LLC / Panera Bread IG - Panera Bread #3410
Name
2150 Washington Street, Suite 12.5
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 01/30/2026 ---- 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: Cesspool(s) F] Septic Tank ā¯‘Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? n Yes No If yes, was it cleaned? n Yes R No
5. Observed condition of component pumped:
16inches 50gallons. Left 0 bottles of drain master. System is at proper working level.
Walls/bottom of trap in good condition. Gasket is in good condition. Both baffles/tees are
intact. 50 gallons removed. 4 inches of bottom sludge. 8 inches of water. 4 inches of grease
on top. FOG 50%. 3 Bay Sink. Dc for preventive maintenance on pipes and floor drains.
Recommend Drain Cleaning. BOH Logs Signed.
6. System Pumped By:
Robbie Hall
-----------
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboroucfh, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
------------------------------- ..........
Robbie Hall 01/30/2026
-Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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