15 BRIDGE STREET SYSTEM PUMPING RECORD 12-3-24Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
15 Bridge Street
MA 01970
Ninety Nine Restaurant
14A Gill Street
01801Woburn
9783728303
MA
12/03/2024 2000.0000
Cover was accessed and properly secured. Grease Tank system serviced. Filter not
present. Tank cannot be outfitted with filter. 2000 gallons removed. 3 inches of
bottom sludge. 1 inches of grease on top. 40 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear.
Michael Graham
South essex sewerage district: 50 Fort Ave, Po Box 989, Salem , MA 01970
12/03/2024
Salem
Salem
Michael Graham
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
211 Washington Street
MA 01970
Starbucks
85 Wells Avenue, Suite 110
02459Newton Center
8007827282
MA
12/11/2024 0.0000
Key would not open door.
Jabe Tarmasiewicz Sr.
12/11/2024
Salem
Salem
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
211 Washington Street
MA 01970
Starbucks
85 Wells Avenue, Suite 110
02459Newton Center
8007827282
MA
12/20/2024 100.0000
3 Bay Sink. 3 inches of grease on top. 12 inches of water. 5 inches of bottom
sludge. 25 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Left 0 bottles of drain master. BOH Logs Signed.
IG Kevin Alexander-Porter
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
12/20/2024
Salem
Salem
IG Kevin Alexander-Porter
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
144 Canal Street
MA 01970
Starbucks
85 Wells Avenue, Suite 110
02459Newton Center
8007827282
MA
12/20/2024 100.0000
3 Bay Sink. 4 inches of grease on top. 12 inches of water. 4 inches of bottom
sludge. 24 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Left 0 bottles of drain master.
IG Kevin Alexander-Porter
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
12/20/2024
Salem
Salem
IG Kevin Alexander-Porter
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
177 Fort Avenue
MA 01970
Sage's Fusion Kitchen
177 Fort Avenue
01970Salem
6175197388
MA
12/18/2024 100.0000
3 Bay Sink. 10 inches of grease on top. 5 inches of water. 10 inches of bottom
sludge. 125 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Left 0 bottles of drain master. 25inches deep 125 gallons
What? Are one opening cover noticed? The liquid level was above. The inlet tee.
Trap is now working as designed. BOH Logs Signed.
Robbie Hall I
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/18/2024
Salem
Salem
Robbie Hall I
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
7 Traders Way
MA 01970
Londi's Famous Roast Beef
7 Traders Way,
01970Salem
9787411100 x
MA
12/19/2024 100.0000
3 Bay Sink. 2 inches of grease on top. 6 inches of water. 6 inches of bottom
sludge. 40 gallons removed. Gasket is in good condition. Walls/bottom of trap in
good condition. System is at proper working level. Left 0 bottles of drain master.
Amauary Leon I
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/19/2024
Salem
Salem
Amauary Leon I
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
3A Winter Island Road
MA 01970
Winter Island Yacht Yard
3A Winter Island Road,
01970Salem
9787453797 x
MA
12/05/2024 1000.0000
Cover was accessed and properly secured. Tight Tank system serviced. Filter not
present. Tank cannot be outfitted with filter. 750 gallons removed. 0 inches of
bottom sludge. 0 inches of top solids. System is at proper working level. Unable
to test main line.
Jonathon Colson
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA 01845
12/05/2024
Salem
Salem
Jonathon Colson
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Building 4, Suite 160 Shetland Park, 45 Congress St
MA 01970
Gillian's Foods
45 Congress Street, building 4 Suite 160
01970Salem
3512016281 x
MA
12/02/2024 140.0000
Cover was accessed and properly secured. Basement. 3 inches of grease on top. 15
inches of water. 3 inches of bottom sludge. 35 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Walls/bottom of trap in good condition.
System is at proper working level. Left 0 bottles of drain master. Basement. 1
inches of grease on top. 15 inches of water. 1 inches of bottom sludge. 35 gallons
removed. Both baffles/tees are intact. Gasket is in good condition. Walls/bottom
Marvin Collado
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/02/2024
Salem
Salem
Walburt Wallace
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
7 Traders Way
MA 01970
Londi's Famous Roast Beef
7 Traders Way,
01970Salem
9787411100 x
MA
12/05/2024 100.0000
3 Bay Sink. 2 inches of grease on top. 6 inches of water. 6 inches of bottom
sludge. 40 gallons removed. Gasket is in good condition. Walls/bottom of trap in
good condition. System is at proper working level. Left 0 bottles of drain master.
Amauary Leon I
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/05/2024
Salem
Salem
Amauary Leon I
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
9 Bridge Street
MA 01970
Bill & Bob's Restaurant
9 Bridge Street,
01970Salem
9787449835 x
MA
12/05/2024 20.0000
Kitchen. 0 inches of grease on top. 6 inches of water. 6 inches of bottom sludge.
40 gallons removed. Gasket is in good condition. Walls/bottom of trap in good
condition. System is at proper working level. Silicone applied to trap cover. Left
0 bottles of drain master.
Amauary Leon I
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/05/2024
Salem
Salem
Amauary Leon I
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
125 Canal Street
MA 01970
Crosby's Market Inc.
125 Canal Street,
01970Salem
9787454272 x
MA
12/30/2024 200.0000
3 Bay Sink. 2 inches of grease on top. 10 inches of water. 2 inches of bottom
sludge. 40 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Left 0 bottles of drain master. 3 Bay Sink. 4 inches of grease on top. 4
inches of water. 4 inches of bottom sludge. 30 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. Walls/bottom of trap in good condition.
IG Steven Dominguez
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/30/2024
Salem
Salem
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
83 Washington Street
MA 01970
The Juicery
40 State Street
01950Newburyport
6032341223
MA
12/19/2024 100.0000
3 Bay Sink. 6 inches of grease on top. 6 inches of water. 6 inches of bottom
sludge. 50 gallons removed. Gasket is in good condition. Walls/bottom of trap in
good condition. System is at proper working level. Silicone applied to trap cover.
Left 0 bottles of drain master.
Amauary Leon I
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/19/2024
Salem
Salem
Amauary Leon I
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A.Facility Information
1.System Location:
Address
City/Town State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other (describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No
5. Observed condition of component pumped:
6. System Pumped By:
Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility (or attach facility receipt) Date
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
9 Bridge Street
MA 01970
Bill & Bob's Restaurant
9 Bridge Street,
01970Salem
9787449835 x
MA
12/19/2024 20.0000
3 Bay Sink. 10 inches of grease on top. 2 inches of water. 2 inches of bottom
sludge. 40 gallons removed. Gasket is in good condition. Walls/bottom of trap in
good condition. System is at proper working level. Left 0 bottles of drain master.
Amauary Leon I
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
12/19/2024
Salem
Salem
Amauary Leon I