HomeMy WebLinkAbout- Septic Pumping Slip - 24 FARNUM STREET 9/21/2018 Commonweialth of Massachuseffs
CitKown `
.Pumping.Record
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DEP has provided this forrri for use-by local Boards of Health. Other forms may've 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 Systern pumping Record must be submitted to
the local Board of Health or other approving authority.
1. System Location: Left/Right front of Mous a Rig h re of he ; Left/right side�ouse, Left
Right side of building, Left/Right front of bui ding, Left/Right rear of building, oder ecl'�
Address
City/rown state Zip Code
2. System Owner:
Dame'
Address(if different from location)
Cityrrown ' Stat t 4 Code
Telephone Number
,B. Pumping Rqcord
9. Date of Pumping pate 2. Qus `"'Pumped:
Dations r-
3. "Type-of systerri: Cesspool(s) eptic Tank Tight Tank '
Other(describe):
4. Effluent.Tee f=ilter present? 0 Yes No if yes, was it cleaned? ® Yes ® Na,
5. Condition of System*,
6: System Pumped By:
Nell Batesbn ' F6821
Name vehicle License Number
_Bateson Enterprises Ina
Company
7. Lo tlorrw contente,were disposed:.
Q Lowell Waste Water
Sign a Houle pate
t formCdoo-06103 System Pumping Record a mage 1 of 1