HomeMy WebLinkAbout- Septic Pumping Slip - 49 ABBOTT STREET 1/8/2019 Commonwealth cu
City/Town of
System Pumpina Record
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GIEP has provided this form for use�by local Boards of Health. Other forms may a 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 to
the local Board of Health or other approving authority.
A. Facility InforMation
1. System Location: Left/Right front pf house, Left/Fight rear of house, Left/right side of house, Left
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address L.-1
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citytrown 1 "G state Zip Code
2. System Owner:
Name'
Address Of different from location)
Cikyl7own StaterC._ G7r de
"telephone Number "MC
.m m PumplIno Kocord ,
1. Date of Pumping Date 2. Quantity Pumped: canons
3. Type-of system: El Cesspools) eptic Tank D Tight Tank
Other(describe):
4. Effluent Tee Filter present? ® Yes o if yes, was it cleaned? ® Yes No
5. Condition of System: h I
6. System Pumped By:
Nell.Bateson F5821
Name Vehicle!_fcense Dumber
Sateson Enterprises Inc•
Company
7. jSigne
here content were disposed:
Lowell Wash Water
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t5Ibffn4.docd 06/03 System pumping Record o page 1 of 1