HomeMy WebLinkAboutNinety-Nine Grease Trap - Septic Pumping Slip - 267 CHICKERING ROAD 2/4/2026 Commonwealth of Massachusetts Town of Norh Andover
City/TownOf North Andover
System Pumping Record MAR 16 2026
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 lo 'Boar to determine the form
they use.The System Pumping Record must be submitted to the local Board of Health T—W11coar 1. o ' epw""
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
267 Chicker inRoadRte 125
Address
North Andover MA 01845
City/Town State - Zip Code
2. System Owner:
_Ninety Ninety Nine #30004
Name
14A Gill Street
Address(if different from location)
Woburn MA 01801
City/Town State Zip Code
6172428999
Telephone Number
B. Pumping Record
1. Date of Pumping 02/04/2026 2. Quantity Pumped: 3500.0000
Date Gallons
3. Component: F] cesspool(s) F] septic Tank F] Tight Tank Q Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? F]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. 2 inches of bottom sludge. 6
inches of grease on top. 36 inches of water. FOG 180. 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, gh Marlborou , MA 01752
Company
7. Location where contents were disposed:
NENO Yard: 163 Western Ave, Gloucester, MA 01930
Robert Herrick 02/04/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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