HomeMy WebLinkAbout- Septic Pumping Slip - 75 STERLING LANE 6/24/2019 rrG i/ (✓ GdLiii/�Ih( 41
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Pumplong,,Record
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DEP has
provided this forl for use;,by local Boards 6f,Health. Other formis,may"be*used,,4ut the
i t - Il the tame as that providedBefore
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Bolard of Health to determine the for M* they use.The$ystem Purnping Record must be subm
Healththe local Board of r i
A. Fac[114"y InforMation
1. System L � §V_ s � � , , sight side house
Right side of building!, i it M rear build" � �reck
t
Address
Cityfr()'Wnl Sta,te Zip Code
2, System Owner
a
Nm
Address i from to o
4
City/TownZip Code
M
elephone Number
.
Pumpi,ng Record
Y Pumped:
Date Gallons
3. Type-of
h
m
Cesspool(s),
1.
M
epfic Tank 0, Tight Tank
Other
(describe):
4. Effluent,'Tee Filter present? Ej Yes, 3000NO If yes, was iit cleaned? Yes NQ
. Condition
� r
6. System
I
i
Nell. rnped By:
Batesbp
VehicleNanne i s umber
CompanyBateson EhteME!R��.......
. Location e i
w
Lowell
VIP
Y
sign
W&W.doohPumping