HomeMy WebLinkAboutSmolak Grease Trap - Septic Pumping Slip - 315 SOUTH BRADFORD STREET 5/26/2026 Commonwealth of Massachusetts ToWn of"Oh,A-1dover
CityrrownOf North Andover JUN 18 2016 System Pumping Record
Form 4
CEP has provided this form for use by local Boards of Health.Other forms may be uskja"Irmtr must be
substantially the same as that provided here.Before using this form,check with your local Board o a form
they use,The System Pumping Record must be submitted to the local Board of Health or other approvin
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days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
315 South Bradford Street
Address
North Andover MA 01845
.Ciiido� _SIR--cgle.....................
2. System Owner:
Smolak Farms - IG Smolak Farms
Name-----------------------------
315 South Bradford
Address(if different from location)
North Andover MA 01845
-------------------- .......... ...............
City/Town State Zip Code
9785002019
.................
Telephone Number
B. Pumping Record
05/26/2026 100.0000
1. Date of Pumping 2ate . Quantity Pumped: -daff'ons--
3. Component: Cesspool(s) F] septic Tank n Tight Tank nX Grease Trap
n Other(describe):
............ ......
4. Effluent Tee Filter present? n Yes nX No If yes,was it cleaned? n Yes F] 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. 40 gallons removed. 4 inches of bottom sludge, 6 inches of water. 4
inches of grease on top. FOG 57%. 3 Bay Sink. BOH Logs Signed.
6. System Pumped By:
Raymond Saez
......................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, MA 01752
Company ------- ... . ........................... ............
7. Location where contents were disposed:
Inside Grease NEMO Yard: 54 Knox Trail, Acton, MA 01720
.......... .......-.....................
Raymond Saez 05/26/2026
................... ........... ---------1--------- .............. ----------------------.-...........
Signature of Hauler Date
-' i I i"t-,-"- - —",---------- --------------------------------- ---- -----
attachSignature of Receiving Facility(or facility receipt)
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