HomeMy WebLinkAbout- Septic Pumping Slip - 150 BRADFORD STREET 10/4/2018 Commonwealth of Massachusefts
l own o `'
SY,4tem Pumping, rd
DE-P has provided this farm for use=by local Boards of Health. Otter forms may be'used,but the
Information'must be substantially the same as that provided here. Before using.this form,check with your
Iocal 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.
A. FacWty. r f C Cl
1, System Location: /'Fight( ®nt o houso` Left I Right rear of house, Left/right side of house, Left
Right side of building, Left/Right front of building, Left/Right rear®f building, Under deck
Address
CRY/Town State Zip Code
2. System Owner:
• Name'
Address(if different from location)
City/Town ' Stater Zip Code ;
"telephone Number
i
ipi , its .. ,
ocord
9. bate of Pumping ®ate ` Quantity pumped. Gallons
3. Type,of system. Cesspool(s) Septic Tank D Tight Tank
Other(describe):
4. Effluent Tee'Filter present? El Ye. �irhlo If yes, was it cleaned? E Yes [I No.
. Condition of System:
vLkA) �I
6. System Pumped By:
Neil.Bates-op ' 'F5821
Name Vehicle License Number
Bateson Enterprises Inc-
Company
7. Location where contents were disposed:
KGLS-D Lowell Waste Water
�, -
Sign e i thui Cate
tMfm4.doc^06/03 System(Pumping Record a page 1 of 9