HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 247 CHICKERING ROAD 8/1/2025 Commonwealth of Massachusetts Town of North Andover
City/Town Of North Andover.
System Pumping Record SEP 16 2025
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be u a ,but inf mation must be
substantially the same as that provided here.Before using this form,check UQ OWN form
they use.The System Pumping Record must be submitted to the local Board of Health or other approvinpilorMity W,"hin 4
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
267 Chickerinq Road Rte 125
................................................ .........................................
Address
North Andover MA 01845
-diyif own t
2. System Owner:
Ninetyine Restaurant N......... ------ ---------
Name
14A Gill Street
.....................------- .............. -------------------------------------------------------------------------
Address(if different from location)
Woburn MA
. 01801.
........... ....... ............. ...............................
CityfTown State Zip Code 6172428999
Telephone Number
B. Pumping Record
08/01/2025 3500.0000
1. Date of Pumping ----------------- 2Date . Quantity Pumped: -Gallons- .
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? F-]Yes P7/1 No If yes, was it cleaned? F-]Yes n No
1^1
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. 2 inches of
bottom sludge. 6 inches of grease on top. 36 inches of water. System is at proper
working level. Both baffles/tees are intact. Main line is clear. Recommend Outside
Septic Tank Pumping. Outlet line needs to be leveled. It is hanging very low
6. System Pumped By:
Robert Herrick
Name ..... -'vehi Vehicle 1-c------ License Number
b e r-- - ------
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlb rouqh, MA 01752
Company
..........
7. Location where contents were disposed:
HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835
--...................................................................................................------ -------------.....................---..........................
Robert Herrick 08/01/2025
- -------------------
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
t5form4.doc-11/12 System Pumping Record-Page 1 of I