HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 37 CARLTON LANE 4/23/2020 _C Commonwealth of Massachusetts RECEIVED
City/Town of
System Pumping Record APR 21 202D
Form 4 TOWN OF NORTH TNUUvER
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DEP has provided this form for use by local Boards of Health. Other forms may 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 T* h rear of house�-eft/right side of house, Left/Right side of building, Left/Right front of building, r 6f building, Under deck
Address
CfWrown State Zip Code
2. System Owner.
Name'
Address(if different from location)
mown � �?cZlp Ftodw_�
Telephone Number
.B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Type-of system: ❑ Cesspool(s) Ic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 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. Loca' e contents were disposed:
L S Lowell Waste Water
SignkWe Haul Date
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