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HomeMy WebLinkAboutSeptic Pumping Slip - 60 LONG PASTURE ROAD 6/6/2018 Commonwealth f Massachusetts I own of n. e Mem Pumping.Record Form 4 ®EP has-provided this forrri for use-by local Boards of Health. Other forms may'be used,but the Information-must be substantially the tame as that provided here. Before using.this fora,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 Wealth or other approving authority. A. Facloty. for fi 1. System Location: Le./Right front of Mouse, Left/Right rear of houso eight Ide of hou e, Left Right side of building, Left/Right front of building, Left/Right rear of building, Under deg . address CWTown State Zip Code 2. System Owner. Name' Address(if difffiimt from location) Cityfrown State , ,,,Zip ad! 'telephone Number i e • /,a „Pqmping RecordM 1. Date of Pumpingsate 2. Quantity Pumped: Gallons 3. Type-of system: El Cesspool(;s) epti Tank El Tight Tank Other(describe): e4. Effluent Tee f=ilter present? ® Yes o if yes, was it cleaned? Ej Yes ® No, ' 5. Condition of system: 6. System Pumped By: Feil.Satesbn F'6821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locafionwhere contents-were disposed: Me Lowell Waste Water ihul C113te f t5form4.doc>06/43 System Pumping Record m Page 1 of 1