HomeMy WebLinkAbout- Septic Pumping Slip - 100 BROOKVIEW DRIVE 3/27/2019 Commonwe'alth of Massachuseftsp
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System Pumping.Record
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CEP 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 forrrh they use.The.System Pumping Record must be submitted to
the local Board of Health or other approving authority. ,
A. Ill, f r t r
1. System Location: Left/Right front of douse, Left/Right rear of house, Left/right side of house, Leff
0 Fight side of building, Left/Right front of building, Deft/Right rear of building, Under deck
Address Aeltj
t
City/"rown State Zip Code
2. System Owner: �, {
Name'
Address(if different from location)
City/Town ' state' � Zip Clae
Telephone Number
Pumping
1. ®ate of pumping Date Z Quantity Pumped: Gallons
3. Type-of system: El Cesspool(s) eptic Tank Tight Tank
Other(describe):
4. Effluent Tee Filter present's Yes "� If yes, was it cleaned? E Yes ® No,
5. Condition of stern:
Y �
6. System Pumped 6y:
Neil.Satesag F5821
Name Vehicle License Number
Sateson Enterprises Inc-
Company I
a
7. Locatlo where contents,were disposed:
• G 4 Lowell Waste Water
Sign a Hbul Cate
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