HomeMy WebLinkAboutStarbucks Grease Trap - Septic Pumping Slip - 1264 OSGOOD STREET 5/29/2026 i
TOwn Of N10fth lover
�L\ Commonwealth of Massachusetts
City/Town0f North Andover JUN 18 2026
System Pumping Record
Form 4 Healtl^ 7)
IR51) Other forms may be used,but the information DEP has provided this form for use by local Boards of Health. JM§jknent
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine the 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:
1264_._.Osg d Street
Address
North Andover MA 01845
cityiyow ............... —--------
Zip-_Q
2. System Owner:
Starbucks - OG - 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 05/29/2026 -- 2. Quantity Pumped: 1500.0000
Date
3. Component: Cesspool(s) Septic Tank R Tight Tank RX Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? Yes RX No If yes, was it cleaned? R Yes R No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Grease Tank system serviced. Filter not present.
Tank cannot be outfitted with filter. 1500 gallons removed. 3 inches of bottom sludge. 3
inches of grease on top. 30 inches of water. FOG 17%. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped By:
Jaime Rivera
...........-................ ...... ...........
Name Vehicle License Number
Wind Riv Environmental, 46 Lizotte Drive, Suite 1000, Marlborouqh, MA 01752
Company-'---------e----r--- nv ---—
7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
....................................------------- ................. ..........
Jaime Rivera 05/29/2026
---------- ------------
Signature of Hauler Date
Signature of Receiving Facility(or-attach facility'receipt) 'b`a-to'-.............
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