HomeMy WebLinkAbout- Septic Pumping Slip - 220 BOXFORD STREET 1/8/2019 Commonwealth of Massachusetts
PumpingU City/Town of
System
Form
OEP 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 to
the local Board of Health or other approving authority.
A. Facility Inform' sition
9, System Location: Left/Right front of House, Left bt rear of hou . , Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
Mytrown c� State Zip Code
2. System Owner �
Marne.
Address Of different from location)
Dity/7`own State�``�� � Zip Cade
Telephone Number
® Pumping
1. bate of Pumping 2 Quantity Pumped:
Date _ Gallons
3. Type-of system: Cesspool(s) eptic Tank 0 Tight'Tank
El Other(describe):
4. Effluent Tee Filter present? ® Yes o If yes, was it cleaned? ® Yes No
S. Condition of System: /� �� � � v%
. System Pumped By:
Neil.Satesbn F5821
Name Vehicle License Number
_Bateson Enterprises Inc-
Company
7. 7u.Ta
re contents-were disposed:
Lowell Waste Water
4nejHhul Date
MbrrM.doc•08/03 System Pumping record p Page 1 of 1
