HomeMy WebLinkAboutSeptic Pumping Slip - 754 FOREST STREET 4/24/2018 Commonwealth ofMassachusefts
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i Town of .
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SY.4tem Pumping-Record
Form 4
DEP ha.s provided this form for use-by local Boards 6f,Health. Other fords may be'used,but the
information'must be substantially the tame as that provided here. Before using.this form,check with your
local Board of Health to determine the forrh they use. The;System Pumping Record must be submitted to
the local Board of Health or other approving authority.
1. System Location: Loft/Right front of douse, Lett l Right rear of house, Left kA' de of house`}Left l
Dight side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address 7 L
5
(
city/Town State Zip Code
2, System Owner
Name'
Address of different from location)
City/Town '
• State- zip"9048
C ,�
f y
'telephone Number
f
Pqmping Ripcord
i
1. bate of Pumping oats 4 2. Qunti Pumped: Gallons
3. Type-of system: [l Cesspool(s) Septic Tank E] Tight Tank =
[� Other(describe):
Q. Effluent Tee Filter present? 0 Yes No If yes, was it cleaned? ® Yes El NQ
5. Condition of System:
6. System Pumped By:
Neil.Bateson ' P5821
Name Vehicle License Number
Bateson Enterprises Inc-
Company
7. Lo do where contents.were disposed:
Lowell Waste Water
. f
Sign Haul Crate
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