HomeMy WebLinkAboutStop & Shop Grease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 6/18/2026 Town of North Andover
Commonwealth of Massachusetts JUL - 2 2026
City/TownOf North Andover
System Pumping Record -h Department
Form 4 Healt
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
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:
757 Turnpike Street
....................
Address ........
North Andover MA 01845
.7
2. System Owner:
c/o Ahold Stop & Shop OG stop & Shop
............................................... -------
Name
1385 Hancock Street
Address�(iif different from location) --------
�n MA 02169
Cityrrown State Zip Code
7046338250
Telephone Number
B. Pumping Record
1. Date of Pumping 06/18/2026 4000.0000
2. Quantity Pumped:
Date Gallons
3. Component: F] cesspool(s) Septic Tank R Tight Tank Z Grease Trap
F] Other(describe):
-----------
4. Effluent Tee Filter present? R 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. 4000 gallons removed. 3 inches of bottom sludge. 1
inches of grease on top. 48 inches of water. FOG 8%. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped By:
Robert Herrick
..................................... ..........
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough,_MA 01752
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
_............................. -------.......................
Robert Herrick 06/18/2026
Signature of Hauler Date
-§idl�ii�-r�--of--R--e--c"e-ivi—ng-Facility(or—aftach facility receipt) D_a"t_e___
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