HomeMy WebLinkAbout- Septic Pumping Slip - 151 CARLTON LANE 5/1/2019 lafth of Massachusetts
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Form 4
DEP has provided this form for Pumping, Record
by local Board's of'Health. Other formit may'bebsed,but,the
information,must be substinfially - i n,,6heck with your
Healthloceil Board of
Boardthe local Health or other approvingauthority.
A. Facility Inforrhation
1. System Location: Left/Right front of house, Left/Right rear of,hous% Left,,/right side of house,, Left I
Right side of building, Left RmIglit fr6nt of buildifig,, Left Right rear df building, Under de'ck
Address
o own
'. System
Name'
Address Of differentfrom;location)
awrown
w
Telephony Number
.B. Pumping kocord
1. Date of ion
3. y 001(s) UeSoepfic Tank k
(describe):
4. Effluent,Tee Filter Yes, aohio if yes, _ Yes E] No
5. i
1. System Pumped By:
Nell.
Name Vehicle s Number
Bateson EMe!prises, Ina
Company
. L I re content&were
G.L- LowellWaste Water
W
Sig
rr
Pumping r
