HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 2/10/2026 ��
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System Pumping�� Record
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Form 4
DEP has provided this form for use by local Boards of Health.Other forms may bn used,but
substantially the same oathat provided here.Before using this form,check with your local Board o,Health u vmmm"aw
they use.The System Pumping Record must be submitted to the local Board of Health ur other approving authority within 14
days from the pumping date|n accordance with 31DCMR15.351.
A~ Facility Information
1. System Location:
, 1264 Osqood Street
' Address
. North Andover M& 01845
City/Town State Zip Code
2. System Owner:
Name
85 Wells .Avenue, Suite 110
Address(if different from location)
Newton Center �& 02459
City/Town State Zip Code
4133274959
Telephone Number
B. Pumping Record
02/l0/2026 1500.0000
1 Date 2 Quantity Pumped:
' Dox* ' ' GoUone
3. Component: [-7Cesspoo|/s\ [—1 septic Tank [—1 Tight Tank Grease Trap
| | Other(desoribe):
4. Effluent Tee Filter present? R Yes No |f yes,was itcleaned? R Yes F-7No
5. Observed condition of component pumped:
Cover was accessed and nzopeczv secured. Grease cau: system serviced. Filter not present.
Tank cannot be outfitted with filter. 1500 gallons removed. zu inches of bottom sludge. 12
ioouee of grease on top. 20 inches of water. FOG ss%. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
0. System Pumped By:
Jaime Rivera
Neme Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite I080 Marlborough, MA 01752
Company
7. Location where contents were disposed:
NEMO Yard: 54 Knox Trail, Acton, MA 0I720
Jaime Rivera 02/I0/2026
Signature ofHauler Date
Signature of Receiving Facility(or attach facility receipt) Douo
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