HomeMy WebLinkAbout- Septic Pumping Slip - 62 BANNAN DRIVE 11/26/2018 Commonwealth of Massachusetts
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System Pumping Record
DEP has provided this form for use=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 form,check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted t®
the local Board of Health or other approving authority.
A. Facility I for tE f1
Right side of building, Left/Right front of building, L ft/Ri Right rear of building, ndere of
house Left f
1. gstem Location: Left!Right front of house, Left/Right rear of house, Left g €d.
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Address -
" .
Citylt`own state Zip Code
2. System Owner
Name
Address(if different from location)
Citylrown State
..
Telephone Number
Pumping
1. Date of Pumping Date 2. QuanQty Pumped: Gallons
. Type-of system: ® Cesspool($) eptic Tank El Tight Tank
El Other(describe):
4. Effluent Tee Filter present? ® Yes o If yes, was it cleaned? ® Yes No
5. Condition of System,
6. System Pumped By:
Pfeil.Bateson F5621
Name Vehicle License Number
Sateson Ehte rises Inc
Company
7. Location where contents-were disposed:
S: Lowell Waste Water
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