HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 562 TURNPIKE STREET 5/6/2026 Town Of IVC;rtfl
.L. Commonwealth of Massachusetts 40ver
City/TownOf North Andover JUN 18 2026
System Pumping Record
Form 4 Hpgua
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the 1 04,
substantially the same as that provided here.Before using this form,check with your local Board of Health,tokmeM41i
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:
562 T rn ike Street
------------------J4 --p --.-.......................... ------ —--------------------- ----------------- ------------
Address
North Andover MA 01845
City/Town —-------
2. System Owner:
Starbucks - IG - Starbucks #7773
........ ...... ...... ...........................
Name
85 Wells Avenue, Suite 110
Address'--(lf--d-1 ff"a r e r't'from" "location)-------
Newton Center -- MA 02459
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City/Town State Zip Code
4133274959
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Telephone Number
B. Pumping Record
05/0 6/202 100.0000
1. Date of Pumping Date 2. Quantity Pumped: Gallons -------------------
3. Component: Cesspool(s) Septic Tank Tight Tank nX Grease Trap
n Other(describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? n Yes 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. 20 gallons removed. 4 inches of bottom sludge. 2 inches of water. 4
inches of grease on top. FOG 80%. 3 Bay Sink. SOH Logs Signed.
6. System Pumped By:
Nate Mckeithan
J��-- —I.-I�-11-�--��----.---- ..-..-..--..--.---.-..--."".-.-..—.------.-.--.--.-- ..........................................Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000,
- --- xarlborouqh, MA 01752
Company .........
7. Location where contents were disposed:
......................................... ...................... -------
Nate Mckeithan 05/06/2026
...........--------- ...........-.--....................................................
Signature of Hauler Date
........----------- ..........I............ ............... .................
nature of Receiving Facility(or attach facility receipt) Date
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