HomeMy WebLinkAbout- Septic Pumping Slip - 1620 TURNPIKE STREET 6/4/2019 tiuu� �
Ith of Massachusefts IV r 0.
Commonw,ea
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Goty/Town of'
System Pumping Record
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DEP has _ vithis form for , y local Boards f"Hea1 . Other formic may" "used, the
ie hip i t � � l the,to athevi , hr . " cck with
loca,I Board of Health determines Pumping r marsubmitted
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the
local Board l r other approving authority.
A. Facility Infbr Mation
1. SysternLocationd i)Rightll�ntot`hous , eq Right b r w r rI i
jaht o - ht rear cif bluildm" g, Under deck
Ri'ght, side of,building, Left Right
Addres
96--te— Zip Cade
WTI'Own
2. System Owner,
Name"
l
Address Of different from location)
t
City Town State. Zip Code
---------
Telephone Number
B. Pumping K-ecord
1%7
'. Date of I m iorwuantity Pumped:
Date Gallons,
3. Type-of systernb. El Cesspool(s) 0,- eptitc Tank El TightTank
5_4�er(describe),
4. Effluent Tee Filter nth" El YesEl No If y _ was it cleanied? YesEl, No
5. Condifion of Sys'My
6. System Pumped
Nell.
Narne Whicle Lloense Number
Bateson r Ina
company
Locatiao herewere01
Lowell Waste Water