HomeMy WebLinkAbout- Septic Pumping Slip - 455 CHESTNUT STREET 5/1/2019 r�
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Commonwealth of Massachuseffs
Utyf Town of'
II/�(0 YN�tal' � �p System Pumping Record
Form 4
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u DEP has,provided'this formfor usepby local BoaMs of-Health., Other formt may,be'used,but the
information-must be:substintially the t;arne as that provided here. Before using.thisform,check with your
loc
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l Board of Health 61 determine the for M' they use. TheSystem Pumping Recor 1
the l Board of Healthr approving
A,., Facility InforMatsion
„s. right side of house, Left
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Right side of deck,i ww =
Address
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Oftyfrown state ZIP Code
. System Owner.
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Addressa from to flora)
Telephone Number
Pumping.B. Pumping Record
I it Date of
l i k E] Tight Tank
Other(describe):
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. Effluent Tee Filter present? 'e If yes', wasift cleaned? Yes N �
Condition of System:
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6.
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Sys Systern Pumps y
Neil. :bra F5821
Narne Vehicle Ue Number
Bateson Ehterprises Ina,
company
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Lowell, ,
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Pumping r