HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 50 TURTLE LANE 12/13/2021 local Board of Health to determine the form they use.The System Pumping Record must be submitted u
the local Board of Health or other approving authority.
A. Facility Inforri�ation
1. System Location: L /Ae
front f house, Left/Right rear of house, Left/right side of house, Left
Right side building, Lg ront of building, Left/Right rear of building, Under deck
on the computer,
he tab
use only the tab
key to move your dd, s� s -
cursor-do not
use the return MA
key. City/Town State Zip Code
2_ System Owner. ,
-I I 'NT U Qe
ke-
ame
Address(f different from location)
MA
City/Town State e
�G Z Ip Code
Telephone Number
B. Pumping Record
ll-j'w / �V
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Component: ❑ Cesspool(s) .Septic Tank ❑ Tight Tank
9 El Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes,4 No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped
6. System Pumped By:
David Tiney Mass F5821
Name Vehicle License Number
Bateson Enterprises, Inc.
Company
7. L ca I where contents were disposed:
GLS Lowell Waste Water
Signature of Hauler Date