HomeMy WebLinkAboutMiscellaneous - 990 FOREST STREET 4/30/2018 (5)E,
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TOWN OF
SYSTEM PUMPING RECORD
DATE: 05
SYSTEM OWNER & ADDRESS
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SYSTEM LOCATION
(example: left front of house)
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DATE OF PUMPING: (p' a2�' (� �j QUANTITY PUMPED : GALLONS
CESSPOOL: NO YES . SEPTIC TANK: NO YES 4
7 NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACIUULD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D ✓ Lowell Waste
Commonwealth of Massachusetts
City/Town of
APR 27 2010
a W° System Pumping Record
Form 4 TM OF NORTH AND=R
HEALTH DcPARTMENT
DEP has provided this form for use by local Boards of Health. Other forms may be 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 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 side of house, Right side of house, Left front of hous E ont of house
Left rear o� house, �ight rear of house. Left rear of building. Right rear of building.
Address
City/Town
2. System Owner: y�--
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Name
Address (if different from location)
City/Town
B. Pumping Record
State
Zip Code
State Zip Code
T '
Telephone Number
1. Date of Pumping y H— ^ i (� 2. Quantity Pumped: t So
Date Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes
5. Condition of System:
No If yes, was it cleaned? ❑ Yes ❑ No
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location—were contents were disposed:
Q. L D, n Lowell Waste Water
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F5821
Vehicle License Number
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Date
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