HomeMy WebLinkAbout- Septic Pumping Slip - 350 SUMMER STREET 9/24/2018 •
Commonwealth of Massachusetts
Cj ffown of
SyMe•m Pumplln§.Record
,J
Form 4
DEP has provided this for'm'for use-by local Boards of Health. Other forms maybeused,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 forth they use.The System Pumping Record must be submitted t'o
the local Board of Health or other approving authority.
A. Facfl!ty. InforMation
667W- Left I Right rear of house, Left, right side of house, L
1. System Location: Left I t front of h, aftj
�trod_of building, Left Right rear of building, Under deck
t ro6f
Right Side of bulIding,.[M15_R_t_!igi'0h i
Address
_l,'
BR-YI—Town tate Zip Code
2. System Owner.
Noma' 4.
Address(N different from location)
cityfTown stater Zip Code
Pumpling R-9cord
1. Date of Pumping nfity Pumped-
Date Gallons
3, Type-of system: El ' Cesspool(s) Septic Tank Tight Tank
Other(describe):
4. Effluent Tee'Filter present? [I Yes No If yes, was it cleaned? El Yes [I No.
5. Condition of System.
6; System Pumped By:
Nell.Bates7on - F6821
Name Vehicle Ulcanse Number
Bateson Enterprises Inc
Company
7. Location-where contents-were disposed:
Lowell Waste Water
Sign a Hbul Date
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