HomeMy WebLinkAboutStop & Shop Grease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 6/18/2026 (3) Town of rloti Andover
Commonwealth of Massachusetts JUL - 2 2026
City/TownOf North Andover
System Pumping Record -al h" Department
Hc
Form 4
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_..Turnp,ike Street ------
;kjar-es s............... '"'"
North Andover MA 01845
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2. System Owner:
c/o Ahold Stop & Shop OG Stop & Shop #92
......................................... ...............................
Name
1385 Hancock Street
-4darei-s-"("if'different from location)
MA 0 216 9
City/Town State Zip Code
7046338250
..........................
Telephone Number
B. Pumping Record
06/18/2026 4000.0000
1. Date of Pumping Date 2. Quantity Pumped:
3. Component: Cesspool(s) Septic Tank �Tight Tank RX Grease Trap
n Other(describe):
4. Effluent Tee Filter present? Fj Yes FANo If yes,was it cleaned? I—] Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. Main line is clear. Both baffles/tees are intact.
System is at proper working level. 48 inches of water. 1 inches of grease on top. I inches of
bottom sludge. FOG 4%. 4000 gallons removed. Filter not present. Tank cannot be outfitted
with filter. Grease Tank system serviced.
6. System Pumped By:
Michael Graham
Na`m`e"'--"---"— -'-' -----------------------------------
Vehicle t_icanse Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlb�iLq-U_q.h..,....-MA 01.75 2
Company
7. Location where contents were disposed:
KENO Yard: 163 Western Ave, Gloucester, MA 01930
.......... .............
Michael Graham 06/18/2026
..............-- ...........--- ........ ........................
Signature of Hauler Date
..................................-......... -------
Signature of Receiving Facility(or attach facility receipt) Date
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