Loading...
HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 485 FOSTER STREET 8/16/2021 .-C\- Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record AUG 16NlopJH AN Form 4 TOWHEA�N DTH DEPARTMENT R DEP has provided this form for use-by local Boards of Health. Other forms maybe*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 forrh 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 liou , LePLeftMgMr-ea�rdf g ar o- Ouse Left/right side of house, Left Right side of building, Left/Right front of b ' building, Under deck Address Citylrown *-� State Zip Code 2. System Owner. Name' Address(f different from location) CitylTown $fateLe Telephone Number B. Pumping record 1. Date of Pumping oafs �2. uanti Pumped: Gallons 3. Type of system: ❑ Cesspool(s) tic 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 Vehide License Number Bateson Enterprises Inc Company 7. Loca ere contents-were disposed: G LAHaulwu Lowell Waste Water Sign Date Mbrm4.doc•06/03 System Pumping Record•Page 1 of 1