HomeMy WebLinkAboutSeptic Pumping Slip - 90 WINDSOR LANE 12/13/2016 Commonwealth Massachusetts
RECEIVED
City/Town of
° o
SOtem Pumping.Record J
i 1 iN.lDEPN�)MENT
DEP has provided this foam for use-by local Boards 6f Health. Other forms may be bsed, 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 kcal Board of Health or other approving authority.
A. Factilty. Information
I. System Location: Left/Right front of douse, Left/Right rear of hawse, Left -Aslaous , Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
City/Town State Zip Code
2. Systen°i Owner: —•,
Fume'
Address(if different from location)
City/rawn ' � Stet l ode
Telephone Plumber
Pumping r
.� 7_{ C
1. Date of Pumping Date 2. Quantity Pumped: Gallons
. Type-of system: El Cesspool(s) eptic Tank Tight Tank
El Other(describe):
4. Effluent Tee Filter present? Yes o If yes, was it cleaned? 0 Yes [I No,,
5. Condition ofrstem:
�4s✓� 11� ," lam" 'w✓ "' P�4+'i 4...u� �.......�C:r.._�� V � �'°`---"
6. System Pumped Sy:
Nell.Sateson F5321
Name Vehicle License Plumber
Bateson Enterprises Inc'
Company
7. ZSigne ere contents-were disposed:
Lowell Waste Water
C �
uls Date
t5fomm.doc-06103 System humping Record Page 1 of 1