HomeMy WebLinkAbout- Septic Pumping Slip - 133 COLONIAL AVENUE 10/31/2018 Commonwealth of Massachusetts
w City/Town ofSystem Pumping C.,,.4.N d/IIuI
Record0( � '4,I �� "i
Form 4• i d MN OF
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ER
i K"M311 DEFAFO M f°`4 9
DEP has provided this farm for us&by local Boards of Health. Other forms may be'used,but the
information-must be substantially the tame as that provided here. Before using.this forme,check with your
local Board of Wealth to determine the forme they use.The System Pumping Record must be submitted tc)
the local Board of Wealth or other approving authority.
A. Facility ifr tits
1. System Location: Leak/Right front of house, Left/ i a hou ,_eft./right side of house, Left 1
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
Cltyfrown State dip e;o8e
2. System Owner:
J-\
Noma*
Address(N different from location)
City/Town stater/-I I V-? YLP IM
t
telephone Number
Pumping
1. ®ate of Pumping Date 2. Quarto Pumped:
Gallons
3. Type-of system: cesspool(s) Septic Tank 0 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:
S. System Pumped By.
Neil.Sateson F5821
Name Vehicle License Number
Sateson Enterprises Inc
Company
7. Lo 'oreontents-were disposed:
A'. Y_ Lowell Waste Water
Sign Gate
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