HomeMy WebLinkAboutSeptic Pumping Slip - 101 FOSTER STREET 5/24/2017Commonwealth of assachusett
City/Town of
y.te P mpan Record
CIE
• t.4 ?A '1017
TON N,cji, Ati "JIVER
OEALTH DEPARTMENT
DEP has provided this form for use=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 I iformation
1. System Location: Left / Right front of house, Left / Right rear of hous
Right side of building, Left / Right front of building, Left / Right rear of buildin
2. System Owner:
side of house' Le
, Under
Address(if different from location)
City/Town '
Telephone Number
P
"It
g
Icor
1. Date of Pumping
3. Type•of system':0
ID Other (describe):
4. Effluent Tee Filter present? El Ye.p
5. Condition of System:
t7
Date 2. Quantity pumped:
Cesspool(s)
Gallons
eptic Tank 0 Tight Tank
6: System Pumped By:
Neil Bateson
' Name
Bateson Enterprises Inc
Company
7. Locati niwhere contents were disposed:
G. Lowell Waste Water
If yes, was it cleaned? 0 Yes E3No
F5821
Vehicle License Number
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