HomeMy WebLinkAbout- Septic Pumping Slip - 31 BANNAN DRIVE 10/31/2018 Commonwealth of Massachusetts
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CEP 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 hare. Before using.this fora,check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted tc)
the local Board of Health or other approving authority.
A. Facifity InforMation
1. System Location: Left/Right front of douse i Righ ar`af hau ii, Leff/right side of house, Left/
Right side of building, Left/Right front of bu ng, Left/Rig`it roar of building, Under deck
Address r C cxi c_� �',a f'\ �1 V _ .. k_ . )_il
Cilylrown State Zip Code
2. System Owner:
Flame'
Address(if different from location)
Cityfrown Stater" C e ip Cod 1'.7
11 `
'telephone Plumber
Pumping ec
1. ®ate of Pumping rate 2. Qudntity Pumped:
Gallons
3. Type-of system: ❑ Cesspool(s) ® c Tank Tight Tank
Other(describe):
4. Effluent Tee Filter present? [] Yes o If yes, was it cleaned? ❑ Yes ® No
5. Condition of system:
6. System Pumped By:
Pled.Bateson F5821
Flame Vehicle License Plumber
Bateson Enterprises Ina
Company
7. Locatio, Nyhere contents,were disposed:
M8. _1_z_'1Lowell Waste Water
Signb,L_
Cate
tMrm4.doo>06103 System pumping Record page 1 of 1