HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 86 BROOKVIEW DRIVE 7/9/2019 w r �
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Commonwegilth
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of Massachusefts
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Record
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Pumpint
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Form
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DEP has,
rovided thi's foirryi for use;,by local Boards 6f"Health. Other for,mi;may*beused,, but the
information,y � al y the same that providedhere. Before using.this form,check with your
locil, Board of Health to deter min y use. T heSystern Pumping Recordmust be submitto
the local Board'of Board' Health or other approving authority.
A. Fad#ty
1, System Location: Left/Right front of hous L gh r .W hou I rght s
i:()u� Left �`
ouse,
Right side of building, Left Right fr6 nt of but I i tLeft I er dero
Pn�ga', I Right rear cif'bluildm" g., k
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SystemOwner,' �
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Address(if
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different, location)
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CilyfTown . stater ,
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Telephone Number
.,B. Pumping Record
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I -ell
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. Date Pumping � �. Qtj'ndt
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Date Gallons
I Type-of �ern` Ges
pools) DSeptrc Tight Tank
0 Other(describe),,
4. Effluent'Tee FlIter pre,sent? El 'Yes 2111090 If yes,was-it cleaned? [J- Yes E] No,
r Condition System: +
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; System, , o-
Nell. rr
Vehicleumber
Bateson
Company
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disposed:
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LowellWaste Water
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Pumping