HomeMy WebLinkAboutSeptic Pumping Slip - 488 SHARPNERS POND ROAD 10/30/2017Commonwealth of Massachusetts
.City/Town of ••
System Pumping. Record
Form 4
EC IVE
0r.T30 ?01/
DEP has provided this form. for use=by local Boards Of Health. Other forms may ba TMENT
F ANDOVER
information must be substantially the same as that provided here. Before using.this f�rrn, c eck witn 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 Information
1. System Location: Left / Right front of house, Left/ Right rear of house igtOde of h use ft /
Right side of building, Left / Right frOnt of building, Left / Right rear of bur drng, Under deck
2. System Owner:
Address (if different from lo io )
City/Town
Telephone Number
B. ['Limping Record
1 cyy (f--7
Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system": 0 Cesspool(s) 16-511;ank El Tight Tank
Other (describe):
•
4. Effluent Tee Filter present? 0 Yep if yes, was it cleaned? P Yes 0 No
5. Condition of .pystern•
6: System Pumped By:
Neil. Bateson •
Name
Bateson Enterprises Inc
Company
7. Location herecontents-were disposed:
Lowell Waste Water
F5821
Vehicle License Number
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