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Address ��� 6-Z4,s Title of File
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Date File Open: Date fele closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planniing Board — Conservation Commission — Building Department
Commonwealth of Massachusetts
kgdowu , Massachusetts
System Pumping Record
System Owner System Location c1
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Date of Pumping: Quantity Pumped: �So gallons
Cesspool: No Yes Septic "Tank: No H Yes Ff—
System Pumped by: Fctt`e4oet rt&7�i4a License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: _ Inspector-
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CI VO