HomeMy WebLinkAboutSeptic Pumping Slip - 305 ABBOTT STREET 5/22/2018 RECEIVE,)
Commonwealth of Massachusetts
i �• ®wn o f
MAY 018
System Pumpling.Record
4 l i i'l"i i i PARI 1
Form 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 forth they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. FaclRy. InforMation
1. System Location: Left/ 'ch, f f Pint s j Left/Right rear of house, Left/right side off house, Leff/
Right side of building, Left/Fight front of building, Left/Right rear of building, Under deck
Address -—�- -- '' N- AI'd ry, ' ~''t+
CRY own State Zip Code
2. System Owner. c
Name'
Address Of different from location)
Cityfrown ' state, Zip code
P
'telephone Number
f
,B. Pumping Rqcord
1. Cate of Pumping Date Quantity Pumped: Gallons-
3. Type-of system: E] Cesspool(s) Septic Tank El Tight Tank
E] Other(describe):
4. Effluent Tee Filter present? El Yes No If yes, was it cleaned? Ej Yes ® No,
' S. Condition of System:
6., System Pumped 6y:
Neil.Bateson F5821
Name Vehicle License Number
_Bateson Enterprises Inc
Company
7. Location where contents,were disposed:
L S Lowell Waste Water
e_( 21 1
41ga Haute Date
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