HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 3/19/2026 i
Commonwealth of Massachusetts Town giver
City/TownOf North Andover APR 14 2026
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be useW!�nfc2A' u �t be
substantially the same as that provided here.Before using this form,check with your local Boar of hft form
they usb.'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:
_116 4 0_sao.od .................. ..........................--_._ _.-_. ... ........
Address
North Andover MA 01845
C�tyfrown ...............
2. System Owner:
Starbucks - IG - Starbucks #70945
Name
85 Wells Avenue, Suite 110
.............. ...........................................
Address(if different from location)
Newton Center MA 02459
City/Town State Zip Code
4133274959
Telephone Number
B. Pumping Record
1. Date of Pumping 03/19/2026 2. Quantity Pumped: 200.0000
DateGallons
3. Component: Cesspool(s) Septic Tank F]Tight Tank RX Grease Trap
R Other(describe):
4. Effluent Tee Filter present? R Yes No If yes, was it cleaned? R Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. 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. 25 gallons removed. 1 inches of bottom sludge. 10 inches of water. 1
inches of grease on top. FOG 17%. 3 Bay Sink. 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. 100 gallons removed. 25 inches of bottom sludge. 1.0 inches of
6. System Pumped By:
Keron Asencio
Name Vehicle-License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720
Tammy Marotta 03/19/2026
............... .............. -_-- -___..._.._____......_._..._._...._--
Signature of Hauler Date
Signature of ReceivingFacility(or attach facility receipt) Date
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