2 TRADERS WAY SYSTEM PUMPING RECORD 2-16-26Commonwealth 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
2 Traders Way
MA 01970
International House of Pancakes - OG - Ihop Salem
1850 Soldiers Field Road
02135Brighton
6614252642
MA
02/16/2026 1500.0000
Cover was accessed and properly secured. Grease Tank system serviced. Filter not present.
Tank cannot be outfitted with filter. 1500 gallons removed. 3 inches of bottom sludge. 2
inches of grease on top. 15 inches of water. FOG 25%. System is at proper working level. Both
baffle/tees are not intact. Recommend inlet/outlet repair. Recommend increasing pumping
frequency. Main line is not clear. Recommend drain cleaning. Recommend Drain Cleaning.
Recommend Line Repair/Replace.
Jonathon Colson
NEMO Yard: 54 Knox Trail, Acton, MA 01720
02/16/2026
Salem
Salem
Jonathon Colson