HomeMy WebLinkAboutSeptic Pumping Slip - 300 FOSTER STREET 3/12/2018 ID
Commonwealth Massachusetts
CWWTown "
y
. Pumping. Cllr
100
DEP has provided this form for use-by local Boards 6f Health. Other forms maybe 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 forth they use. The;System Pumping Record must be submitted to
the local Board of Health or other approving authority.
1. of ho
S stem Location: WV Rlh €ton -eftl Right rear of house, Left/right side of house, Left
Right side of building, Left/Right-front of building, Left/Right rear of building, Linder deck
Address 1 f
Citylrown _§falte Zip Code
2'. System Owner:
• Name'
A.ddress(i(different from location)
Citylrown Stater f / I Zip Code ;
Telephone Number + .,
pi i y r
1. Date of Pumpingoatel S2u& Pumped: Daltons —.
3. Type of system: Cesspool(s) Septio Tank ❑ Tight Tank ,.
❑ Other(describe):
4. Effluent Tee Filter present? [/Yos ® No If yes,was it cleaned? Yes ® No.
5. Condition of System:- ��AAjL.... .
(
6: System Pumped By:
Nell.Batesan F5821
Name Vehicle License Number
Bateson Enterprises Ina
Company
7. Location where contents-were disposed:
+ L S Lowell Waste Water
Sign a Maul Cate
t51brm4.doca 06/03 System Pumping Record a Mage 1 of 1