HomeMy WebLinkAboutNinety Nine Restaurant - Septic Pumping Slip - 267 CHICKERING ROAD 1/30/2025 Iowa
of North 4dover
Commonwealth of Massachusetts FEB - 5 2025
City/Town of North Andover
Ith D
System Pumping Record epartMent
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:
267 Chickering Road, Rte 125
Address
North Andover MA 01845
City/Town State Zip Codg--
2. System Owner:
Ninety Nine Restaurant
Name
14A Gill Street
Address(if different from location)
Woburn MA 01801
City/Town State Zip Code
9783728303
Telephone Number
B. Pumping Record
I. Date of Pumping 01/30/2025 2. Quantity Pumped: 3500.0000
Date Gallons
3. Component: Cesspool(s) R Septic Tank F]Tight Tank FV--1 Grease Trap
VN
F] Other(describe):
4. Effluent Tee Filter present? []Yes No If yes, was it cleaned? F-1 Yes F-] 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. 3500 gallons removed. 6 inches of
bottom sludge. 4 inches of grease on top. 48 inches of water. System is at proper
working level. Both baffles/tees are intact*. Main line is clear.
6. System Pumped By:
Robert Herrick
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
NEMO Yard: 54 Knox Trail, Acton, MA 01720
Robert Herrick 01/30/2025
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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