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TOWN OF
SYSTEM PUMPING RECORD
DATE: q' ( b
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
C
! �'r H 4 4 jai
- APR 6
DATE OF PUMPING. l QUANTITY PUMPED: GALLONS
CESSPOOL: NO YES SEPTIC ANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
TOWN OF 0 \le(
SYSTEM PUAPING RECORD
7•
DATE• �j
SYSTEM OWNER & ADDRESS
4
APR 1 $ 2003
a
SYSTEM LOCATION L
(example: left front of house)
DATE OF PUMPING: 0 + ° QUANTITY PUMPED: GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS: �..,
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: &' y °; ' j
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner
Date of Pumping: '–C ` ( `—
Cesspool: No IYes L.]
System Location
D'q3,:-Tooll J'4�
P1_ 4.1-Ij
Quantity Pumped: l nc(- gallons
Septic Tank: No U
Yes Lam'
System Pumped by: Fa reQOrt License #
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
colllrlo011ilealt1) of Nlnss ichuselts
Massachusetts
e111`UtCiiT �S? 1-1 T ceron
2, TmA(�,:
N0' A-14 .
t � unirtli�1'wn ,ed: t
Un�r of I um stn � ' Z � '`�� i .. Q".•„ t ! � �
Cesspool: ''u ,vj
eS U Crnitr a«t ►.�� Yes
License N:
S% -stent lumped b%:
Collicnis traUs(erred to:
Urate Inspector
J -k)1 14•5151L.�I t'L.%u'LNU t.����•v
conurnnn�reelllt of Massacltusells TQC BOARD OF HEr Ilu" ALTH
Massachusett
DEC 2 i 9995
�'Yslerli 1'um!� l recur
a�yz Tw.no kz ��
Qucuuit%. Pumped! l Ud D
Date of I um1 gill `
,rrnlir Tanl•' N'- Yes
Cesspool: No,t `' 1 1•es (]
s+ -sleet Pumped by : _ -r
(4es c)License N: f
contents transferred to:. '
Date
Inspeclor
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. The System Pumping Record must
be submitted to the.local Board of -Health or other approving authority. .
A. Facility Information
Important:
When filling out 1. Syste Locati
forms on the
computer, user/���1 �. 1
only the tab key Address
to move your
cursor - do not
use the-retum C�ty�o State �C
key.0
2. System Owner. 1N�aN�Ma�� NM�
Name
1�1 Address (if different from•tocati'on)
City/Town State Zip rode
S -
Telephone Number
B. Pumping Record
T. .Date. of Pumpingpate 2- Quantity Pumped:
Gallons
I Type of system- ❑ Cesspool(s)eptic Tank- ❑ Tight:Tank
❑ Other (d'escnbe)
4: Effluent Tee Filter present? ElYes ao If yes, was it cleaned? ❑ Yes ❑ No
5. Condition f S
st m:
6. System P p d Bim; f .�
U
Name Vehicle License Number
i
Company
7. Location w re c ntents re di ed:.
Sina't e o a'
g ler Date
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t5form4.doc• 06103
System Pumping Record •Page 1 of 1
it
Commonwealth of Massachusetts
NORTH ANDOVER ! Massachusetts
&stem Pum nin ec rd
System atter System Location --
MIKE CHASE 2192 TURNPIKE,.ROAD=-
Date of Pumping: 11/05/07Quantitj• Pumped: 1000 gallons
Cesspool: No Yes . ❑ Septic Tank: No ❑ Yes ❑
RAGGS SEPTIC SERVICE, INC.
System Pumped by: d.b.a. E. A. COMEAU SEPTIC License
Contents transferred to: WATER SOLUTIONS GROUP, TAUNTON
Date 12/15/07• Inspector RAGGS SEPTIC SERVICE, INC.