HomeMy WebLinkAbout- Septic Pumping Slip - 45 CRICKET LANE 10/31/2018 Commonwealth of Massachusetts
Y City/Town
eSystem. Pumpingr
®EP has provided this form 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 form they use. The System Pumping Record must be submitted t,0
the local Board of Health or other approving authority.
A. ill InforMation
1. System Location. Lift/Right front of house, nett i hi°p r6ar of s , Left/right side of house, Left
Right side of building, Left/Right front of building, eft/Right rear o building, Under deck
Address
.. '1i
City/rown State Zip Code
2. System Owner:
ICE
Name'
Address(if different from location)
City/Town State- Zip Code
(,<z
Telephone Number
Pumping Pe
1. Date of Pumping oat 0 2. tadntity Pumped: IS
I
3, Type-of system; ® Cesspool(s) septic Tank Tight Tank
[l Other(describe):
4. Effluent Tee Filter present? [] Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
litAl `' 1` ..
6. System Pumped By:
Nell,Bateson F5821
Name Vehicle License(`lumber
Bateson Enterprises Ina
Company
7. Locati ere contents-were disposed:
.L Lowell Waste Water
(�1 2® —
sign a i��ui Date
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