HomeMy WebLinkAboutSeptic Pumping Slip - 338 ABBOTT STREET 8/23/2017 Commonwealth of Massachusetts RECEIVED
u CVTown of iwi,.; " m
.System Pumping.Record TOWN
ORTH ANDOM
Foran 4HEALTHDEPARTMEW
DEP has provided this form for use-by local Boards of Health. Other forms maybe*used, but the t
information,must be substantially the same as that provided here. Before using.this form., '
heck with your 1
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. t
A. Facfllty. Inforrnafion
1. System Location: a Rig rant f liou , Left I Right rear of house, Left/righ#soda of house, Left
Right side of buil g, Left/ gk nt of building, Left/Right rear of building, Under deck
Address . _.
Cityrrown State Zip Code
2. System Owner.
77�7_lc
Name'
Address(if different from location)
Citylrawn - - State .-- �Zin
Teleplione Number
r
r
�. Pumping record �
1. Date of Pumping nate 2. Quontity Pumped:
Gallons Y"`
3. Type-of s stem: ='
YP Y. ® Cesspool(s) eptic Tank ® Tr'ght Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No,
6. Condition of, Sjto , 1 .
i
6. System Pumped By: }
Neil.Bateson ` F5821 J
Name Vehicle License Number
Bateson Enterprises Inc'
Company
7. Location where contents�were disposed:
,L S. Lowell Waste Water
f
Qg—ngture 9t Haule Date t
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