HomeMy WebLinkAboutStop & Shop - Grease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 3/11/2026 Commonwealth of Massachusetts TOWn Of Not)A11dover
City/Town0f North Andover
System Pumping Record APR 14 2026
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be S use o ft d or tion must be
o
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substantially the same as that provided here.Before using this form,check with your F rm
they use.The System Pumping Record must be submitted to the local Board of Health or other approving Jut!ori!Mtgi g
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
757Tu_Enpike Street
Address
North Andover MA 01845
---------------------- .....................................
CityfTown
zip-Code...............................
2. System Owner:
c/o Ahold Stop & Shop - OG Stop & Shop #92
-NIame------------------- ...........
1385 Hancock Street
Address(if different from location)
�QRinc MA 02169
............ -—----------------------------------------------------------------------
CityfTown State Zip Code
7046338250
Telephone Number
B. Pumping Record
03/11/2026 4200.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: Cesspool(s) Septic Tank R Tight Tank FX-]Grease Trap
[--j Other(describe):
4. Effluent Tee Filter present? nX Yes F-1 No If yes, was it cleaned? Yes F-] No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Main line is clear. Both baffles/tees are intact.
System is at proper working level. 75 inches of water. I inches of grease on top. 0 inches of
bottom sludge. FOG 1%. 4000 gallons removed. Filter is present and was cleaned. Grease Tank
system serviced.
6. System Pumped By:
Orlando Herasme
Name Vehicle License Number
Wind- River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
............Environmental, ...........
Company
7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
..........
Orlando Herasme 03/11/2026
Signature of Hauler Date
........................
Signature of Receiving Facility(or attach facility receipt) Date
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