HomeMy WebLinkAbout- Septic Pumping Slip - 680 FOSTER STREET 3/4/2019 Commonwealth of Massachusetts
w City/Tow City/Town of
t m Pumping Record
DEP has provided this form for use=by local Boards of-Health. Ogler forms may be'used, but the
information,must be substantially the Carrie as that provided here. Before using.this form,check with your
local Board of Health to determine the form they use.The Systern Pumping Record must be submitted to
the local Board of Health or other approving authority.
As Factlity Inform' ation _
1. System Location: Left/Fight front of house, Left 1 Right rear of hour rig ids f house Left l
Right side of building, Left/Right front of buildinig, Left/bight rear of building, Lind�r�I�`
Address
►
Cityfrown state Zip Code
2. System Owner
Name'
Address(if different from location)
Cityrrown state ''
G a,
'telephone plumber
. Pumping K-ecord
1. ®ate of Pumping 2. Qudn Pumped:
p � CateGallons
3. Type-of system: ® Cesspool(s) eptic Tank. ® Tight Tank
Other(describe):
4. Effluent Tee Filter present? Pr Yes No If yes,was it cleaned? es ❑ No
6. Condition of System Djo _
6. System! Pumped By:
Neil.Bates7bn F5621
Name Vehicle License!dumber
Bateson Enterprises Ina
Company
C
do contenire were disposed:
4G,
, Lowell Waste Water
Raul Date
l5form4.doca 06/03 system Pumping Record d Page 1 of 1
