HomeMy WebLinkAboutSewer Lift Station - Septic Pumping Slip - 152 ABBOTT STREET 7/8/2019 m:
ii w w ti
t
Y
r �
Commonwe6fth of Massachusetts n' r`Z)"C V E::D,
C! own of
W
S ' tem YSPumping,
WW �,Record aW
)VER
Form 4
NOR w
K
Y iim My
�"'q
nww i I�",ufllwww�NY I�I� �Im��¶'VI umn wile
* w � w
. s
w 6fHealffi.
vi this form r use rOther formis may,beused,but the
InfolrMationw w must be substinfially
looil Boardl r i l ire
the local Board of Healthr other approving
A. Facill",ty. lnfb,r Mation ,
I. System Location. i front hour 1 Lefts `rig �� �of house
e�
b
Right s1 l i ern b� i �l , �� Lei i rear cifbuilding, Under deck.
w
Address
CKYf I-own s te zip Code
i
r System Owner., 1p "'
w t
Name
i
w 1
w dress di ` rn t t
Citwown wstat Zip Code
X
Telephone Number
a � M
e �w
wt
M w
w
Pumping
u
B.
.. ' • w
w
�µ N
cord
1 ..... of Pumping a ..flty Pumped:
Nut
i P �
Gallons
w M
3, Typew 'sy�teft El Cesspool(s) E] eptic.Tank Tight Tank
[B'Other(desc 'be
ri
4. Effluent Tee Filter present? 0 Yets, 0 N o If yes, was it cleaned? [j Yes E] NQ
5.
{ If
w
Condition
i
w . System ■
+ o
Will.Batetbn
VehicleNarne
BatesonEhtemises; Ina
company .�
i
were i
WaterG., Sr. Lowell Waste
1
w
Sign Hl Date
t5lbuM.doca w w Syatem Purnpingr w