HomeMy WebLinkAbout- Septic Pumping Slip - 547 WINTER STREET 8/28/2018 Commonwealth of Massachusetts �u���"�,,,,' l��`� �°P� � ti�
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Sy�tem Pumping.Record
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DEP has provided this fors for use:by local Boards 'of Health. Other forms may'be'used, 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 forrh they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
cfl for Mation
I. System Lo do . eR`rght frc�n tf houseouse
)Rig rear of house, Left/right side of house, Left/
Right side of buil 6g, Left/Rig&r aPbuildidg, Left/Right rear of building, Under deck
Address
Cityfrown 5fate Zip Cade
2. System Owner:
a dl
' iVarrre` .
address o different from location)
City/Town ' state Zip Code
Telephone Number
T . Pumping Record
1. Date of Pumping ®at� _ Quantity Pumped. Gallons` --- r
3. Type-of system: Cesspool(s) Septic Tank. ❑ Tight Tank
❑ Other(describe).
4. Effluent Tee'Filter present? ❑ Yep No If yes, was it Cleaned? ❑ Yes ❑ Na
5. Condition of System:
LLC_ J
6; System Pumped By:
Neil.Bateson - 'F5821
Name Vehicle License Number
Bateson Enterprises Inc,
Company
7. Lova' where contents-were disposed;
G,�.S: Lowell Waste Water
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