HomeMy WebLinkAbout- Septic Pumping Slip - 42 FOSTER STREET 6/13/2019 wrrtrlrriww�%j ��N
Commonwetilth of Massachusefts
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9 Uty/Town of
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AS- 4tn, Pumpoln
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Form 41
DEP has provided this form for use;by local Boards of Health. Other formt;maybe'used, but the
for ll here. r i i with
l f BoardRecord
the l Board of Healthr other,approving, u r w
A. Facill't Infor ' at"
Y m ion
aCl�i h sid Leftt
I., Systern Location: Left/Right 19 L ri sid' *nf houu�j N of house, Left R" ht rear of x
ww i i i , L fr6nt of buildifig, Left Right rear ci it ` , Under deck
Address
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i tit Code
LA
2. System Owner. kN
Address(If different ft r _1 0, 1 w
1
i
ci own staff
Telephone r
.B. Pumping Record .....
1.
Date of Pumping ate 2. Q fity Pumped, Gallons
3 Type-of system: El Cesspool(s) is Tank EJ Tight Tank
Other(descrimbe):
1
4. Effluent Teepresent?
. Condiffion
. Systemy.
Nell.
Nanne Vehicle i Number j
Bateson Ehte!Prises Ina
disposed.Company
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1
G;OL P1.
Lowell Waste Water
............. L2.
t5fbrm4.daca,06/03 System,Pumleft Recorda Page 101