HomeMy WebLinkAboutSeptic Pumping Slip - 1659 OSGOOD STREET 5/24/2017Commonwealth of Massachusetts
City/Town of
y te mg. ecor
MAY 2 4 2011
Fo 4
TOWN 01- NUN H ANDOVER
• HEALTEi DEPARTMENT
DEP has provided this form for us&by local Boards of Health. Other forms may be used, 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 local Board of Health or other approving authority.
A. Facility 0 for ation
1. System LocatIon4jMig front of t_ueis ?Left/ Right rear of house, Left/ right side of house, Left /
Right side of building, Left / t-front of building, Left / Right rear of building, Under deck
Address
(&,
City/Town
2. System Owner:
City/Town '
P
p
g
)Sal
1. Date of Pumping
3. Type.of system':
0 Other (describe):
te
L.)\(\ Cc)
Telephone Number
2. Quantity_ Pumped:
Date
Zip Code
Gallons
Cesspool(s) Eg--SliAic Tank D Tight Tank
4. Effluent Tee Filter present? 0 Yes
" 5. Condition of Systern:
If yes, was it cleaned? 0 Yes El No,
uLA.ca teUeJ.
••
6: System Pumped By:
Neil. Batesbri
' Name
Bateson Enterprises Inc
Company
contents were disposed:
Lowell Waste Water
Sign Fibula
F5821
Vehicle License Number
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