HomeMy WebLinkAbout- Septic Pumping Slip - 45 TURTLE LANE 4/3/2019 Commonwealth of Massachuseffs
.IVCit�/Town of
Sy.4tem Pumpling,Record
Forme� r�a11
DEP has provided this form for useby local Boards af,Health. Other forms maybe but the
information-must be substantially the tame as that provided here. Before using.this fora,check with your
local Board of Health to determine the forrh they use.The;System Pumping Record must be submitted fie
the local Board of Health or other approving authority.
A. cI r�` for 'li
1. System Locationr.ztefiftlgh unit p1 hious , Left I Right rear of house, Left/right side pf house, Left/
Right side of bull / ' e n o building, Left/Right rear of building. Under deck
AddPeSS ��""
Citylrown State Zip Code
2: System Owner:
' Name`
Address(if different from location)
City/Town State c5 Zip code
F w jr 's C"
Telephone Number
- t
® �1 1 r
1. ®ate of Pumping pate 2. Quantity Pumped: Gauans1.
...
3. Type-of system: Cesspool(s) eptic Tank 0 Tight Tank r•
Other(describe):
4. Effluent Tee Filter present? Ej Yes o if yes, was it cleaned? ® Yes El Na
5. Condition of Sys#e
6: System Pumped By:
Neil.Batesbn • F6821
Name Vehicle License NumbeP
Sateson Enterprises Inc-
Company 1
7. LoCQtiCi ;, erg content&were disposed:
MS. ,; Lowell Waste Water
ign pate
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