HomeMy WebLinkAbout- Septic Pumping Slip - 215 FOREST STREET 6/4/2019 r
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Ith of Massachusetts
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System
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DEP has
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r1ovided this form for usev by,local Boards of,Health. Other forms may-be'Used,4ut the
i t � R must be substanflallytame,as that provided here. Before
loc6l Board of Health to determine i rd must be submitted to
the local Board of Healthr other __r van
A. Facility InforMation
1.
System .i Left front of house, Left,]RIght rear ofhousa, Left,I right slade of house, Left I
Right side of building, Left/Riglit k6nt of buildirig, Left Right rear . "
ng, Under deck
Address
City/Town, st Zip Code
W. System
Address i from location)
cityfrown Sta c7) de
..Io
Number
.
B. Pumping Record
, Date of Pumping � w
Datean" Gallop's
� , system: cesspool(s) pfio1
E] Other(describe
Ye:s El No
4. Effluent Tee FlIter present'.,? Yes 0 If yes, was it cleaned? El
5. ank Tight Tank
6. System Pumped y
Nell.BeLmLn�...,. F5,821
Narne vehicle Umnse Number
Bateson ri
Company
7. Locationcontents-were
0
Lowell Waste Water
sign Hiwl to
.ado Pumping