395 LAFAYETTE ST NO
107 Forest Sl.
FORM 4 - SYSTEM PLJNfPLN'G RECORD �
Middleton,MA 01949
(508) 774.2772 5EP 800`0`-
r ' - 1
Commonwealth of Massachusetts
Massachusetts ,ilii 8 1997
SYstem Pumping Record
ystem �Nmer ystem Location
a
e
Date of Pumping: - y/9� Quantity Pumped: allons
Cesspool: No ❑ Yes LJ Septic Tank: No ❑ Yes ❑
System Pumped by: License #: ..
Contents transferred to:
Date. _ �/g'-7 Inspector �j L S
0 THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY •