HomeMy WebLinkAbout- Septic Pumping Slip - 600 FOSTER STREET 5/1/2019 y
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Commonwealth of Massachuseffs
Utyffown
of
System, Pumplong Record
Form 4
DEP
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has provided this y local Boards forma may,beused, b'ut the
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l must b s � llt provided hers using this ,check with„
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to r Health + er the for s,e. The;System
the local Board of Health or other approving,,authority.
A. Facipfluty InforMation,
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1. house,
System '� house, Left I
AddressLeft Wg
Right side of build'Ing, Left Right fr6nt of buildifig, o bu'liding, Under deck
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CVTOW11 Zip Code f
Owner.2`.'1 System
Name
Address Of different from locations
City/Town 111-Code
Telephone Num r
B. Pumping Pecord,
1. Da,te of Pumping Date 2. Qu6nfity Pumped,: Gallons
3. Type-of system: E] Cesspool( nk
IOther(describe):
,4. Effluent.Tee Filter r N If yes, was it cleaned? a-Y6s Ej No
5. CondMon of System:
I.........L
. System Pumped By-
Nell. a bF5821
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Name Vehicle License Number
Company
I.
7.
L y he n . disposed
r
Date
Lowell Waste Water
t Pumping r