HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 920 TURNPIKE STREET 6/9/2020 Commonwealth of Massachusetts RECEIVED
City/Town of JUN 0 0 2020
System Pumping Record TOWN OF NQRTHANDOVER
Form 4 HEALTH DEPARTMENT
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
iocal 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, �/righ ide Lqhouse eft/
Right side of building, Left/Right front of building, Left/Right rear of building, Under d
Address
Cityrrown State Zip Code
2. System Owner.
Name'
Address(if different from loc alion)
CitylTown o
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2_ Quantity Pumped:
Gallons
3. Type-of system: ❑ Cesspool(s) eptic 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. Lo here contents-were disposed:
G t_ Lowell Waste Water
Sign a Haul Date
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