HomeMy WebLinkAbout- Septic Pumping Slip - 550 BOXFORD STREET 5/7/2019 U
pmV&IW i i
sCommonwealth
Uty/Town of
System Pumpino Record
r i
r
u
1
Forml 4
DE,P has p-mvided this form for use*by to 1 . Other formt mad *used,,but the
�In . oa subs � heprovidedsi ts ,check within
local Boardt6 determll"ner use. Pumping rd must be submitted to1
the local Board of Health or other approving
,A. Facility InforMation
.....w m
%
. . . n Left/ i
de of house, Left,t
Wing,, Left/Right s"de of buli Right, it Under
61 f R f buildin,
o
1
Address
cityffown StateZip Cod's
System2. r
Address Of differentfrom location)
Ci ter Zip
Telephone
ecord
Be Pum ng R
. a a pryDate 2 QPumped-, ......
Gallons
3. Type-of system cesspool(s) Septic Tank Tight Tank
Other(describe).'
Yes No
4. Effluent Tee Filter present'? Yes NO If Yes, was ift cleaned? El
. Condifi n of System:
6. System P :
Nell. ,82
Name Vehicle License Number
Bateson Ehte!prises Ina
Company
. Lioca. were,disposed:
Lowell
n
7SI —au
w
f
w
"nt4e f H fDate
t . oo&06/03 System Pumping