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HomeMy WebLinkAboutStarbucks - Grease Trap - Septic Pumping Slip - 419 ANDOVER STREET 4/6/2026 Commonwealth of Massachusetts CitY/TownOf North Andover System Pumping Record rtrr 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: 419 Andover ........................... ................................... ................ ................ address North Andover MA 01845 Zil� ----------------- ........................ ...................... 2. System Owner: Starbucks - IG Starbucks - #68713 Name 85 Wells Avenue, Suite 110 -�iiar�s-,s-,(,i-f,,d-iff—ere-n-"t'—from-l-o—cat-lon) —---------- Newton Center MA 02459 CitylTowrn state Zip Code 4.133274959 ............. Telephone Number B. Pumping Record 04/06/2026 100.0000 1. Date of Pumping ...... 2. Quantity Pumped: Date Gallons 3. Component: © Cesspool(s) F] septic Tank n Tight Tank N Grease Trap n 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: Cover was accessed and properly secured. 3 Bay Sink. 4 inches of grease on top. 5 inches of water. 4 inches of bottom sludge. FOG 62%. 35 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. Left 0 bottles of drain master. BOH Logs Signed. I bolt missing. 6. System Pumped By: Tammy Marotta ............ Name Vehicle License Number Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboro..._ ---M__.0.1752 Company 7. Location where contents were disposed: Tammy Marotta 04/06/2026 ..........----.......... ........... -------- ................... Signature of Hauler Date .......... --------- ............................. Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc- 11/12 System Pumping Record-Page 1 of 1