HomeMy WebLinkAbout- Septic Pumping Slip - 118 BROOKVIEW DRIVE 7/2/2019 Commonwealth of Massachusefts,
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Pumping,
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jlDEP has poovided this forffi for use;,by local Boards 6f,Fqrm 4
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Other forMW-M6)r)b6,bWd�A'ut the
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wthetame Aefr form.,check,wit
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the local Boardl r other approving ,, j
A. Fam"Pty InforMat!"on ,
1,,, System Location: Left/
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e Rightr of house, W, s'di1 olu'se eft I
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Right side of building, Left I Right fr6nt of buildifig, Left/'Right rear df bi(ui
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City/Town, ` Stater Zip Code,
Telephone Number
B. Pumping Record,
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1. Date of
..
Date G
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3. Type-of sy�teft Cesspool(s) fic Tank D "
Tight
Other(describe),
. Effluent T ee,Filter present? f yes, wasi"' cleaned?
_ Yes El No
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System6.
Nell.
Vehicle Ucense Number
Ehtemrlses I
Company
Lowell Waste Water
rDate
t5fb
, .dar,so 06/03 System Pumping Record