HomeMy WebLinkAboutSeptic Pumping Slip - 39 GRANVILLE LANE 7/2/2018 Commonwealth of Massachusetts
City/Town of
sy.�tem Pumping.Record
.
IEP has provided this fora 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 forrh they use,The System Pumping Record must be submitted t®
the local Board of Health or other approving authority.
A. Facift InforMation,
1. System Location: Left Righl front pf 'Left/Right rear of house, Left/right side of house, Left,/
Right side of building, LeftRight ro�af building, Left/Right rear of building, Under deck
Address
r cid
Citylrown � State Zip Code
2. System Owner:
Name
Address(if different from location)
Cityfrown ` Stater Zip Code
Telephone Number '
iF
PumpingJ r
9. bate of Pumping Date Quantity Pumped: Gallons
3. Type•of system: [,] Cesspool(s) Septic Tank Tight Tank
® ether(describe):
4. Effluent Tee Filter presents Yes ® No If yes, was it cleaned? Yes No,
5. Condition of System: d (,A ,,
6: System Pumped By:
Neil.Bateson P6621
Name vehicle License Number
Bateson Ehte rises Inc
Company
7, Location whe contenta were disposed:
L Lowell Waste Water
SignAWe ul Cate
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