HomeMy WebLinkAboutStop & Shop Grease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 6/3/2026 Commonwealth of Massachusetts To of NOdh Andover
City/Town of North Andover JUL - 2 2026
System Pumping Record
Form 4 -11tp
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DEP has provided thi§form for use by local Boards of Health.Other forms may be used,but the in omQ9Aat1Ment
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
City/Town 3Aale-- Zip Code
2. System Owner:
c/o Ahold Stop & Shop IG Stop & Shop - #92
Name
1385 Hancock Street
Address(if different from location)
Quincy_ MA 02169
City/Town State Zip Code
7046338250
Telephone Number
B. Pumping Record
1. Date of Pumping 06/03/2026 2. Quantity Pumped: 500.0000
Date Gallons
3. Component: F] cesspool(s) Septic Tank F-]Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? [] Yes RX No If yes, was it cleaned? n Yes Fj 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. Grease trap needs I bolt replaced.
Gasket is in good condition. Both baffles/tees are intact. 25 gallons removed. 4 inches of
bottom sludge. 6 inches of water. 4 inches of grease on top. FOG 57%. Deli 1. 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. 50 gallons removed. 1 inches of
6. System Pumped By:
Kylen Grace
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720
Kylen Grace 06/03/2026
-Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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