HomeMy WebLinkAbout- Septic Pumping Slip - 1175 TURNPIKE STREET 5/1/2019 Ith of Massachusefts
Commonwea
ClIty/Town of
System Pumping Record
i !
Form, 4
DEP has provided is'form for use y local Boards of"Flealth. Other' wr may. Mused, but the
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informadon,must be substintially the tome as that provi wresi is form,check with your
10061B r f Health to determin e- the forrh they use. The:,Systern,PumpingRecord must be submifted
the local BDard of Health or otheir approving authority.
A. Facility Inforthation
1. System Location: Left Right front of house, Left Right rear of housia, Lei right side of house, Left
Right side building, Left;I Rig6tit , Left/' fight rear building, Under deck
Address
m r.
cityrr
owe A State Zip,Code
Address location)
City/Town stater ZI Code
%m
Telephone
Number
'
.B.,
PumplIng
Record
Pumping Date 2. Qu6nflty pe Gallons
. r 1 , i Tank,
Other(describe):
4. Effluent Tee Filter present? Yes 0 If Yes, w�as it cleaned?
91q 01
5. Yes N'
5
6. System Pumped By:
lf.
Name Vehicle Number
Bateson EMe[prises Ina
Company
4 a 'i pre contents were,disposed.
Lowell Waste Water
,w aM
sign Hav Date,
.doca 06/03 Systern'Pumping Record