HomeMy WebLinkAboutSeptic Pumping Slip - 74 COLONIAL AVENUE 6/6/2018 /p � �p �$CommonwealthfMassachusettsgyp,....,,1,y���
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Pumping.
®EP ha'provided this for mi 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 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.
1. System Location: Left/Right front.of Mouse, Left I Right rear of house, Left/right side of house, Left I
Right side of building, Left!Right front of building, Left/Right rear of building, Under deck
Address
Clty)Town State Zip Code
2. System Owner:
O&�
ldarne
Address(if different from location)
CityTrown ' State- , Zi i Cade
'telephone dumber w
b r ,
® Pumping Kocord
1. Crate of PumpingDate 2. Quantity Pumped: Daltons
3. TypeV system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? Yes o If yes,was it cleaned? Cl" Yes ® No
• 5. Condition of System: � ; � � ��--•
6: System Pumped By:
Nell.Batesibrt F5821
Name Vehicle License Number
Bateson Enterprises Inc-
Company
7. Lo 'bo
_ contents were disposed:
.L Lowell Waste Water
SignJOT, lClave
t5form4.doc•06/03 System Pumping Record Page 1 of i