HomeMy WebLinkAbout- Septic Pumping Slip - 719 JOHNSON STREET 5/1/2019 Ith of
Commonwea
Massachusefts
,pry Cloty/Town,
Form 4
DEP System Pumplang Record
r ro f
has provided �form for use, y l r Health. Oth6l , but the
information-must su s 'll 'the tame as that provided heIre. Before,usih Ahis form. check w
1=0 Board,of Health to determinefor' use.,The�Systeem Pumping Recordmust submitted
the local Board of Health or other approving authoifty.
A. Factlity
InforMation,
1. System Location: Left/Right front of house, Left Right rear house,of i
building,Right side of r* rear iit * , Under
VI
� 'xi4iuiirt tee,✓, w.
C state Zip
2, System Owner.,
differentAddress Of location)
city/Town,
Telephone Number
.B. Pumping Record
Nu
1. Date of Pumping Date Q
t
3. Type
w �pfic k Ej Tight Tank
Other(describe):
Filter if y , w,as it olleane,d? Yes E] No
. Condition
r
i
,, System
Neil.
Narnis Vehicle i umber
Bateson Eh!tTrises Ino
Company
7. *0�"Mh ,re contents were : f
Lowell, Water
IL
n Hbul Date
. 6 Pumping r -