HomeMy WebLinkAbout- Septic Pumping Slip - 125 SHERWOOD DRIVE 8/28/2018 Commonwealth of Massachusefts
RECEIVE
W City/Town of .
�- SY,4tem Pumping.Record W" 213 2018
HEM..iµH DEPARMENT
®EP has provided this form for use>by local Boards of Health. Other forms may be'used,but the
information-roust be substantially the Larne as that provided here. Before using.this fora,check with your
loc61 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. Faclll,ty. Inf®rMation
1, System Location: Left/ •o , Left/Right rear of house, Left/right side of house, Left
Right side of building, Left!Right front of buildinig, Left/Right rear of buildin Under deck
. Address
Cityrrown State Zip code
2, System Owner:
Name`
Address(if different from location)
City/Town • ; e
Stat
Telephone Number ,
i
Pumpling Rqcord
'l. Date of Pumpingdate �. GZubntity Pumped:
Gallons
3. T e•of s
Type-of y,stem: El
Cesspool(s) eptic Tank Tight Tank
® tither(describe):
4. Effluent Tee Filter present? El Yes o If yes, was it cleaned? ® Yes No,
6. Condition of System: Oct
6. System Pumped By.,
Nell.Satesbri ' F6821
Name Vehicle License Number
Bateson Enterprises Inc'
Company
7. 5iSigntufa
' are contenta were disposed:
Lowell Waste Water
ti. E
Woul Cate
WormCdoc-06/03 System Pumping Record d page 1 of 1