HomeMy WebLinkAboutSeptic Pumping Slip - 69 OAKES DRIVE 5/1/2017Commonwealth of Massachusetts
City/Town of
yste P Record
•
DEP has provided this form for use4;ty local Boards Of Health. Other formttlalt 'iSki'ld,ir MA th
!4 , 8
information must be substantially the same as that provided here. Before Wit: orm, 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 info
atio
I. System Location: Left / Right front of house, Left /
Right side of building, Left / Right frOnt of building, Left / Right rear of building, Under deck
2. System Owner:
Address (if different from loca on)
CItyfTown
P
g Reco
1. Date of Pumping
Date
Type of system':
EilfStiTer (describe):
4. Effluent Tee Filter present.
' 5. Condition of System:
6: System Pumped By:
Neil. Bates -on
• Name
Bateson Enterprises Inc
Company
ar of house, eft/ right side of house, Left /
St
Telephone Number
2. Quantity Pumped:
Gallons
C pool(s) eptic Tank 0 Tight Tank
Yes 0 No If yes, was it cleaned? 0 Yes 0 No,
7. Location where contents were disposed:
owell Waste Water
F5821
Vehicle License Number
t5form4.doc. 05/03
System Pumping Record Page 1 of 1