HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 5/12/2026 Commonwealth of Massachusetts Town of"North Andover
City/"Town0f North Andover JUN 18 2026
System Pumping Record
Form 4
k �VJ- 9 DE'has provided this form for use by local Boards of Health.Other forms may be
substantially the same as that provided here.Before using this form,check with you=I -===Wahe 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:
l-2,64-._.0.§.g.22_q _S.t .........................................................
Address
North Andover MA 01845
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City/Town
2. System Owner:
Starbucks - IG Starbucks #70945
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Name
85 Wells Avenue, Suite 110
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Address(if different from location)
Newton Center MA 02459
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State Zip Code
4133274959
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Telephone Number
B. Pumping Record
05/12/2026 200.0000
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1. Date of Pumping [late
a---....... 2. Quantity Pumped: Gallons.- .................
3. Component: f-I Cesspool(s) n Septic Tank F]Tight Tank FXJ Grease Trap
F] Other(describe):
............ .......................
4. Effluent Tee Filter present? n Yes FXJ No If yes, was it cleaned? []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 are in need of repair. Recommend Trap Repair/Replace.
Gasket is in good condition. Both baffles/tees are intact. 100 gallons removed. 25 inches of
bottom sludge. 10 inches of water. 25 inches of grease on top. FOG 83%. 3 Bay Sink. Left 0
bottles of drain master. System is at proper working level. Walls/bottom of trap in good
condition. Grease trap needs 1 bolt replaced. Gasket is in good condition. Both baffles/tees
6. System Pumped By:
Nate Mckeithan
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Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough-,_ MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
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Nate Mckeithan 05/12/2026
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Signature of Hauler Date
.............. ..................... ....................... ................... ......... ........... ..................................
Signature of Receiving Facility(or attach facility receipt) Date
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