HomeMy WebLinkAboutseptic tank - Septic Pumping Slip - 143 DUNCAN DRIVE 7/16/2019 i
RECEIVED
Commonwealth
Cfty./Town of'
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M ( 4 W
M i
Ml Y
•Mx b System
Pumping
Record
�T�OWN OF IW/WI D0, E
Form 4
EA ENE ENT
i
DEP u� � vi .� l � l � s f . the
information-,must be subst6nfially the,tame as that,provided here. Before using Ahis form,check with your
I ' ei the; o # they use, The� item n record must, submitted,
ocas
the local Board of Health or other approving authority.
As,
Systems
1. Locaflon: Left/Right front � � � '� s -,eft- sight side house, Left
Right side building, Left i ii of il rear cif bil , Under deck
�Address
W
State Zip Code
2. SystemOwner:
V\
Name'
Addressdifferent from l
cityrrown star lCode
Telepbone Number
.B. Pumping Record
1, Date,of PumpingDate 2. Q� 6ty Pumped.
Iles
f
3. Typ&-of system: Cesspool(s) 01--6�epfic Tank D Tight Tank
Other(describe).1
4. EffluentTee Filter present? es No If yes, was it cleaned? [2-Yes [I No
5. Condibon of System:
w MI
. System Pumped
l
Narne Vehicle n
,pang
content&were disposed:
L$�r-Q Lowell Waste Water
sign Hain Date
. System Pumping Record Page
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