HomeMy WebLinkAbout- Septic Pumping Slip - 458 FOSTER STREET 6/4/2019 I
Gommonwe8flth
Massachulseffs
� �((1105✓! YVy��r�i�/r�9 1�1 v� �
City/Town
f
1
y J
A)f
y
g 9 System Pumping Record
a ya y 4 G J
i
r
N�
Form,
'���lo Jn,�4,%��um,l�lu��BY'V�+��J✓hY�M�"��°'�0�.'tl�py�u���,YV'� �.,,,�W�Ilia
DEP has'-provided this form, for use;,by local,Boards of Health. Other for,mt;maybeused,but
* ,...
Info
form.,check with your
y -
to
I Board of Health to determine the fa,
they use.,The Ca
Pumplbg
Record
ust be subm" dtc)rM
System,
itte
the local Boa,rd of Health or other approving authority.
A. Facil"Ity InforMation
I. System Location: L6 front of ous i Left I Rightrear of house, Left/r
Right i ul' i , "building, Left Right,rear df build'm" g, Under d
Addi s
v
City/Tows Zip Code
2A, System Owner:
f
J
I
Address(Ii from t ti
I
t
cityf` State:-_ Code
i
Telephony Number
,.B. Pumping Record
1
1
v
PumpingDate2. "''
Gallons
y . lE1,S01fick Tight T ank
Other(des,cribe):
. Tee Filter Y yes, was�it cleaned? - Yes Ej, N
Condition.5. of'System:
.,
Nell.System Pumped By:
Bates7on F5821I
it i s
Bateson Ehte[prises Ina 1
Company
i
were disposed.
Lowell Waste Water
V
Si ,
t61 . = / 3 System Pumping Record Page