HomeMy WebLinkAboutSeptic Pumping Slip - 55 BRADFORD STREET 7/2/2018 Commonwealth u
CiWown of RECEIVED
SyMem' w
Pumpling.Record 2018
Form
TOWN OF NOWH ANDOVER
NT
DEF has provided this for�n°i for use4by local Boards of Health. Other fotffit'm y bye'�used,
d,but the
information-must be substantially the same as that provided here. Before using.this fora,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. FactRy. 1 f r ti
1. System Location: Left/Right front of house i 'rght �r o oius Left/right side of house, Leff/
Right side of building, Left/Right front of bur rhg, Left/Right rear cif buiiding, Under deck
Address
cRyfrown State "yip Cade
2. ,System®weer:
Name'
.Address Of different from location)
CitylTown State � � dip da ,
f
`telephone Number
a u 1 r
`A . '
1. bate of Pumping at 2. Quantity Pumped:
Date Gallons f"
3. Type-of system: E] Cesspool(s) eptic Tank Tight Tank
0 Other(describe):
4. Effluent Tee Filter present? Ej Yes o If yes, was it cleaned? ❑ Yes rl No,
' 6. Condition of System:
6: System Pumped By:
Neil.Batesart F6821
Name Vehicle license Number
Bateson Enterprises Ina
Company
7. Locatio .pu re contents-were disposed:
Lowell Waste Water
Sign a F9lui Daae
t6form4.doc^06/03 System Pumping Record•Page t of 1