HomeMy WebLinkAboutSeptic Pumping Slip - 2189 TURNPIKE STREET 3/11/2016 0 13
Commonwealth of Massachusetts 1 W :
HEAL T H DD
City/'Town of
System Pumping Record
Facility Information:
System Location:
Address
City/Town State Zip Code
System Owner:
Name:
Adress (if different from location of pump)
City/Town State Zip Code
,µ
Telephone Number
Pumping Record
Date of Purn in
p g �� � �� 1 Quantity Pumped �� �'°,����°� gallons
Type of Systems Septic Tank Grease Trap Other (what)
System Pumped by:
Company: ROOTER-MAN 46 Portland Street Lawrence, MA 01843
Location where contents were disposed: � .� (�
Signature of Hauled Date
FORM 4- SYSTEM PUMPING RE CORD
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Commonwealth of Massachusetts
A/ /v /)C , Massachusetts
UeM-ftMDina Record TOWN OF NORTH AN00VER
14EALTI I DE'PANTMENT
System System Owner System Location
Date of Pumping: Quanity Pumped: ..........
gallons
Cespool "N'o' . ......
Yes Septic Tank: N
Condition of System: /w
System Pumped by: Sewer- an/Rooter-Man License No.: A 1",3 H 1 9
Contents Transferred to:
Date'. Inspector:
FORM 4® SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
� ` W... ._... , Massachusetts "'d AY 11
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System PUMDing Record /
System Owner System Location
Date of Pumping: �� Quanity Pumped: - °" gallons
Cespool: Yes
Septic Tank: No (Y .
C'.
Condition of System:
System Pumped by: Sewer- an/Rooter-Klan License No.: r
Contents Transferred to:
Date: Inspector:
SYSTEM PUMPING CO
DATE: _ Od,
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
ei -Sk ,DATE OF PUMPING: -4 -01.1- QUANTITY PUMPED : GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY CREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS: I
CONTENTS TRANSFERRED TO: p °
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Collin) nwvesa th ormassachusetts
assacltusctt
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System Owiler System Location
1
Date of 1'unapint;:
taaaiitit Pumped: " gallons
Cesspool: No Yes �_� Septic l'attk: No Yes
System 1'atntpecl by: t'�4r6 r� ! License#
C"tsttteMtls ttanslerrred to : renterinwr tye rtl rL !Istria
Batt': v __Inspector: ._
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Commonwealth of Massachusetts
Massachusetts
5N-stem-owner � ystem ocattort
e._. ' „ ...
Date of Punnpung: Quantity Pua p ed:� Ions
'�o:
Cess ool ❑" ..r,.µ
p .° ' Yes ❑ peptic Tank: No ❑ Yes �....°.°"....
r-
S�•stem Pumped b\ : .� `'�, - _ �� "�� License
Contents transfea-red to:
Date Inspector