HomeMy WebLinkAbout- Septic Pumping Slip - 222 BRIDGES LANE 1/8/2019 Commonwealth f Massachusetts
City/Town of
System Pumplana Record
DEP has provided this farm for use-by local Boards of Health. Other farms may be'used, but the
information-must be substantially the tame as that provided here. Before using.th€s farm,check with your
local Board of Health to determine the forrh they use.The System Pumping Record must be submitted tc)
the local Board of Health or other approving authority.
A. Factlity InforMation
1. System Location: Left/Right front of hiouse'Liftl i €°fit_ate hays- e /right side of house, Left
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address ( _r
P ), ( J V , UCC7 J
City/rown Mate Zip code
2. System fawner:
Name"
Address(if different from location)
city/Town stater Zip Code
Telephone Number
Pumping tit r
9. Date of Pumping €` 2. uantity Pumped: t- L)C7
Cate Gallons
3. Type-of system: El Cesspools) Septic Tank El Tight Tank
Other(describe):
4. Effluent Tee Filter present? Yes o If yes, was it cleaned? [I Yes ❑ No
5. Condition of System: /oo r 01�41 (
6. System pumped By:
Neil.Paterson F5821
Name Vehicle License Number
_Bateson Enterprises Inc
Company
7. Location where contents-were disposed:
L Lowell Waste Water
Sign a Hhule Cate
tftrm4.doo-06/03 system pumping Record a page 1 of 1