HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 162 ABBOTT STREET 11/26/2019 Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumping Record NOV ?6 201,
Form 4
TCNJN OF NORTH ANW\jER
pEPFRTMENT
DEP has provided this form for use �jH by local Boards of Health. Other forms l�'y be used,but the
information-must be substantially the same as that provided here. Before using.this form,check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left/Right front of house, Left/Right rear of house, Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address / � � n '1 44 " —
OwTown l V J Y State Zip Code
2. System Owner. b
Name.
Address V different from location)
CityJTown stater Zip Code
Telep one Number
B. Pumping record
1. Date of Pumping Date ;�epfic
Quanti Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locatiqnwkere contents-were disposed:
G L S Lowell Waste Water
SigniqtHaulffluDate
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