HomeMy WebLinkAboutSeptic Pumping Slip - 49 ABBOTT STREET 5/18/2016 Commonwealth chu
u
City/Town of n;
S item Pumping, Record
YS
For
DEP has provided this form for use=by local Boards of Health. Other forms may be t� 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.
A. Facility. Information
Right
building, ro
sw a
p Left 1. System Location: Left/Ri ht r Left/Right Right side of building, Left R ig ht front of buildid g, eft/Rig ht rear of Une`r-7eck-- /
Address
City/Town State Zip Code
2. System Owner. °
Name'
Address(if different from location)
Citylrown State ,- „ >� 7 Zip Code
Telephone Number �<
B. -ping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons }.
3. Type-of system: ® Cesspool(s) ❑ eptic Tank ® Tight Tank
Other(describe):
4. Effluent Tee Filter present? ❑ Yes • No If yes, was it cleaned? ❑ Yes ❑ No,
5. Condition of System: .
6.. System Pumped By:
Neil.Batesen F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locati n. here contents were disposed:
G l Lowell Waste Water
C�& OA
Signktute cf Haule Date
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