HomeMy WebLinkAboutSeptic Pumping Slip - 280 CANDLESTICK ROAD 3/15/2017Commonwealth of Massachusetts
City/Town of
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DEP has provided this form for useby local Boards of Health. Other forms may De used, but tne
information must be substantially the same as that provided here. Before using.this form, check with your
local Board of Health to determine the forrn they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
• A. Facility 11 formato
1. System Location: Le
Right side of building, eftilt
City/Town
2. System Owner:
Name
t front of hpkise, Left/ Right rear of house, Left/ right side of house, Left /
orit of building, Left / Right rear cif building, Under deck
Address(if different from location)
State
City/Town
g Rec
1. Date of Pumping
3 Type of system':
01
0
Date
Cesspool(s)
0 Other (describe):
4: Effluent Tee Filter present? 0 Ye.,
' 5. Condition of §"ystern:
6. System Pumped By:
Neil Batesbg
Stater
Zip Code
Telephone Number
2. Quantity Pumped:
Gallons
eptic Tank 0 Tight Tank
' Name
Bateson Enterprises Inc
Company
7. Location,whra contents were disposed:
S. •Lowell Waste Water
If yes, was it cleaned? 0 Yes 0 No
„e.
F5821
Vehicle License Number
Sign e Hauler( Dat
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