HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 500 REA STREET 7/31/2020 77
Commonwealth of Massachusetts
L
City/Town of
System Pumping Record JUL 312020
Form 4
!D P
DEP has provided this form for us&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/Right rear of house, Left./right side of house, Left I
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
City/Town State Zip Code
2. System Owner.
Name
Address(if different from location)
CityfTown State Rr�j--
Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: E] Cesspool(s) ptic Tank ❑ Tight Tank
0 Other(describe):
4. Effluent Tee Filter present? [:] Yes LSO If yes, was it cleaned? [] Yes [3 No
5. Condition of System- 4�
6. System Pumped By:
Neil Batesbn F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location wfteM contents were disposed,
Lowell Waste Water
4S�ignitwje*cf Ht�ui' Date
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