HomeMy WebLinkAboutSeptic Pumping Slip - 706 FOSTER STREET 5/22/2018 Commonwealth Of Massachusefts
K ry CEIVED
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CiWTown ofMAY 2 2 1018
spoem Pumping.Record TOM Or.'NOUH ANDOVER
DER 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 mere. 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. Facil-oty, Information .
1. system Location: Lift f i ht fron�ronofsbulldlrig,
Left/Right rear of house, Left/right side of house, Left
Dight side of building, Left _ ig Left/Right rear of building, Under deck
Address """`r
owrown State zip Code
2. System Owner. .
Name
Address Of different from location)
Citylrown ' State t -�0 Zip -�
'telephone Number
7
•
• Pumping Record
1. Date of Pumping nate 2. Quantity Pumped: Gallons `r
3. Type-of system: El Cesspools) eptic Tank [] Tight Tank
❑ Other(describe):
4.. Effluent Tee Filter present.? Yes No if yes, was it cleaned? ® Yes ® Pao,
' S. Condition of System.
6. System Pumped By:
Neil.BatesTon F5821
Name Vehicle License Number
Bateson Ehte rises Inc
Company
7. Loca` in were contents-were disposed:
G�B Lowell Waste Water
Sign a hliule Cate
Wbrm4.doo•08/43 System Pumping Record•Mage 1 of 1