HomeMy WebLinkAbout- Septic Pumping Slip - 24 FARNUM STREET 6/13/2019 I
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COMMOnweafth of Massachuseffs RECEIVED
V� � i� pW� ''� �ra�D
41i, "I
Goty/Town of
systom Pumping Record
' w
Form
DEP has
4
r v� ' i for e�- y local rd's of,Health. Other forme may"be•us ,but the
information-must be substin:flally the tame as that provided here. Before using.this form,c*heck with your
locil Board of Health determine the form they use. The$ystem PumRecord must be submitted toE
the local Board of Healthr other approving authority.
A. Facility InforMation
1. System Location., Left/Right front of house, Left ar of hous. Left-/dy"i dlao,.,-house, Left I
Right side of building, it
gande�.d��*ec
Address
a
cityfrown, State Zip Cody
2, i
Systemner.
i
t
Address(if diffie location)
crown -etate-
Telephone Number
,,B,, Pumpino Pecord
,pro
w Date of � i R „
Gallons
3. Typeof c Tank El Tight'Tank
r system: l MY P
li
Other(describe
Filter4.. Effluent Tee preseriv. 0 if
0 yes o if „ was it cleaned? Yes No
5. Condiflon of System:
i
.,
System w
Neff.
VehicleName
I
Bateson r I
Company
7. Location el content&were disposed.
Lowell Waste Water
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