HomeMy WebLinkAboutSeptic Pumping Slip - 353 BOXFORD STREET 7/23/2018 Commonwelaithf Massachusetts RECEIVED
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City/Town of
SY.4tem Pumping.Recordo i,.6.. �,'J' TkD
Form 4 "TOWN 01:NORTH AN[')OVER
i i' i,:rH M"ARTMENT
DEP has provided this font"for use by local Boards of Health. Other forms may be bsed,but the
information•must be substantially the same 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 ether approving authority.
A. cll r t n,
1. System Location: Left/Fright front of!louse, Left/ti�g—ht rear of house ; ft/right side of house, LeftRight side of building, Left/Eight fr®nf of building, t/Rigg rear df building, Under deck.
Address —
City/Town state Zip Code
2. System Owner:
cD,
Name'
Address Of different from location)
Cit Town state- J
Telephone Number x
.B. Pumping Rpcord
1. Date of Pumping sate 2. Quantify Pumped: Gallons
3. Type-of s
yp y.stem.
Cesspool(s) Septic Tank light Tank
El Other(describe):
4.. Effluent Tee Filter present? [I Yes o If yes, was it cleaned? Yes ® No,
5. Condition of Sys'—
C�
6., System Pumped Ey:
Neil.Bates ri ' F6821
Name Vehicle license Number
Bateson Enterprises Inc'
Company
7.4S!gn
a contents-were disposed:
Lowell Waste Water t
. ��
e"11'Hhute Crate
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