HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 1551 OSGOOD STREET 12/16/2020 : Commonwealth of Massachusetts RECEIVED
City/Town of
W1_ System Pumping Record P F, 2020
Form 4 ft'NoovER
-NT
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 ft/Right rear of house, Left/right side of house, Left,/
Right side of building, Left/Rig ro t of buildih , Left/Right rear of building, Under deck
Address ` SJ
My/Town State Zip Code
2. System Owner.
Name
Address(if different from location)
CitylTawn State. Zip Code
Telephone Number
6. Pumping record
1. Date of Pumping �at3e 2. Quantity Pumped:
Gallons
3. Type-of system: ❑ cesspool(s) M ank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes Ekwo If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: r✓`�� I _2/��'�_- r w �-
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
A
ntents-were disposed:
S. Lowell Waste Water
a Haul Date
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