HomeMy WebLinkAbout- Septic Pumping Slip - 173 BRIDGES LANE 6/4/2019 u.esrlP..:
Commonwealth of Massachusetts
u
City/Town of
Pumpi"no
Form 4
1
System
Record
Ili �i
DEP has provideld this
I ,4
form for , local r for "use ,but the
* r " s ssfill h m s that provided here. ° sin .this with
l l:Board Boardof Health t r in t y use.,TheSystern Plumping Recordmust be submitted t
the,loc�al,BoardHealth or other approving
A,, Facility InforMation
I., System Right side,of'building, eIig. r i rear of.house, Left right side of house Left I
"
i r building, Under deck
Address
Lo
"Is. A111711-OLLL"C4"r,
Cibf/Town, Zip Code
Owner.2. System
location)Address Of differeW from '
CityfTdwn stater Zip Code
_3
Telephone Number
.B. Pumping Record
1,,, Date of PumpingDate 240, tiy Pumped: Gallons
;000�
3. 'Type- 'e rater : cesspool(s) Septic Tank, Tight Tank
El Other(describe),-,
4. Effluent Tee Filter present? e If yes, was it,cleaned Yes El N
5. Condition of System:
4,
6. Systern Pumped By.:
Neel'"
Name Vehicle License Numbet
Batesorl
" w "
company
content&weire disposed'.
Lowell Waste
"
SlanA cf
l
. Record