HomeMy WebLinkAboutStop & Shop Grease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 6/5/2026 Town of Not Andover
Commonwealth of Massachusetts
CitY/TownOf North Andover JUL - 2 2026
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used,but Pw�hiza
substantially the same as that provided here.Before using this form,check with your local Board of Health to de eW Nat
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 State —
2. System Owner:
c/o Aho1d__§_�op__ & Shop - OG 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 06/05/2026 2. Quantity Pumped: 4000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank ❑Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-]Yes FXJ No If yes,was it cleaned? F-1 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. 2 inches of bottom sludge. 2
inches of grease on top. 75 inches of water. FOG 5%. System is at proper working level. Both
baffles/tees are intact. Main line is clear.
6. System Pumped By:
Chas Montanez
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Cornpa-ny-
7. Location where contents were disposed:
Chas Montanez 06/05/2026
-Signature of Hauler Date ------ -------
Signature of Receiving Facility(or attach facility receipt) Date
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