HomeMy WebLinkAbout- Septic Pumping Slip - 135 FOSTER STREET 10/2/2018 r-
Commonwelalth of Massachusetts
City/Town of
0 C 1' 0 2 201
Sp4tem Pumping.Record
VCATIH I AMI)0\1 FZ
Form 4
DEP has provided this forrri for use-by local Boards of Health. Other forms may beused,but the
information must be substantially the tmme as that provided here. Before using.Us 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.
111ty. Information
1. System Location: Left/Right front of house, Left ht rear of hoes , Left/right side of house, Left I
g Left
Right side of building, Left I Right frbnt of building, L e Ig It rear of building, Under deck
Address
Oftyfrown state Zip Code
2. System Owner
Name*
Address Of different from location)
Cityfrown state k--- Zip Code
Telephone Number
.13. Pumping Rpcord
1, Date of Pumping Pumped:
Date u 'Y Gallons
3. Type-of system' El Cesspool(s) e p�ficaT Tank Tight Tank
El Other(describe):
4. Effluent Tee Filter present? E] Yet No if yes, was it cleaned? El Yes [I No,
5. Condition of.System: V\,
6; System Pumped By:
Neil.Bateson F5821
Name Vehicle Ulcense Number
Bateso i Enterprises Ina
Company
7, Locab here contents-were disposed:
Lowell Waste Water
If
—Date
Wei
t5fbrmil.doc-08103 System Pumping Record m Page 1 of 1