HomeMy WebLinkAbout- Septic Pumping Slip - 338 ABBOTT STREET 5/1/2019 r
� 1
q
IA
Commonwealth of, Massachusetts
Clt�/Town of
"'
w " yV f
tem
y�,Q„� aJ i d` Idu r
Pumping Record
x
g i 11y
��.`!U fiForm 4
r,
r .
local Boards 6f-Health. Other formt maybe'used,but the
Information,-must be substantially the tame! that provided here. Before us ,.this fonn,6heck with your r
loc6l Board of Health to determine, fortsthey use. TheSystem� must be submitted to
the local l authority., - r
'
A. Faciflit
r
w
Y
w 4
1 0Right side of - " i
R 1ght side of house Left I
eft i i i ., � * h w it "
Address
2, System Owner.
Address(if different from location)
1
i
N
W
r,
f
;
--- -- ...
cityttown
Telephone Number
m
' a
Pumping Record
B.,
+ w
1. Date of Pumping
M
Date Gallons .
+
ft., off - [U,8ap#a-Ta"n�kTight
w M
Other
(describe);-,
4. Effluent Tee Filter n If Yes,,was ift d YesEl No,
i
. Condiflion
c \Cj? /4� A
t
w System Pumped w w
Nell"Bateson� • „ f.
Nanne Mahicle License Number
X
Company
n i • _ 1
L U.P Lowell Waste Water
k
j
i
Sign a Mule Date
t5fbrm4.doca 08/03 System PurnplrigRecord