HomeMy WebLinkAboutSeptic Pumping Slip - 162 ABBOTT STREET 7/19/2018 UWTown of �"
SY,4tem Pumping.Record
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®EP has provided this forrri for use-by local Boards 6f,Health. Other forms maybe*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 tc)
the local Board of Health or other approving authority.
A. Facipty, Information
1. System Location: Left/Right front of house, Left I Rlghi rear of house, Left I right side of house, Left I
Right side of building, Left 1 Right front of building, Left/Right rear of building, Under deck
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Ad-dress-City/Town 7§tate Zip Code
2. System Owner
Name'
Address(if different from location)
City/?awn State e-7-- C made
Telephone Plumber
- - re
I�r ' In r"
;'.
Date � �-- .•
1. Date of Pumping 2. Quinti ,Pumped: Gauons k
3. Type-of system ❑ Cesspool(s) eptic Tank Tight Tank
Other(describe):
4. Effluent Tee Filter present? E Yets a If yes, was it cleaned? D Yes El Na
' S. Condition of System
6; System Pumped 6y:
Neff Batesbn ' F5621
Name Vehicle License Number
Bateson Enterprises Inc'
Company
7. LM�Ls.
re content were disposed:
Lowell Waste Water
4sign a Houle cote F
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