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HomeMy WebLinkAboutSeptic Pumping Slip - 10 CHERISE CIRCLE 3/23/2016 y> ORT A8' 1 d•t+,�),�� Irr'Irp+ y D P.hee provldod �hlf form !or u6o by lace) Boards o�r1 r!(w`I`t�� l`Xhv S by atlbml(1vd to thv local Soaru of HOakri or a � '' Yslvm Pumping ',•. . . e ,. . ::� rr�°�Ir�g�a-u north'' — r Ai Faculty lnforrti�n ,ti, lm Ro rtin .*",•,YYr4n N�nv out Sys(am Location; cr��ytno t�bkay • Addrv'y�__.. _ -rF.,.,� (`�- .� cx:raor+OQ PQ1 4 1+. ��!i41�\�\ '4/ 1 .i"rl�ti,'t r1 Y'�'r ! \Jt81� ..• D y � .Sslem Owner AZl"4 (If dUlorent rom locaUon) IT own . - --- y z91 Tolopnono.7 °� d Numpar - r Pum Ing Record r ------ d Dah of Pumpinq ' u 2. Q aWy Pumped i� yp9 Pf ayslam, , ��sspool(s) SapUc Tank CD T9hl Tank OU�ar(describe — 4 Effl aO l Toe Fula r y r r•„ W (p+etsenl? ' Ya No If yes, was it cleaned? Q Yes r � _ r3) C9nd1pon',q(Sy M:, i 6 Sy P.umpad 6y rr. ,y�.l, i,�l,rr i� � N(� •t �'lt'V ';i f') ,; �'rh 1, � //ryVvhlcJe Uc�n�e Nturibvr --- 1, l , 7r� Loca on where c©nlents'w�re dl�posad; N, ,,��r ��++,.�r' , 1 , S h ✓hr�w,mass,gov/dial®r/apprava�J�/l5(orms:hlm#Inspect Syllam PWnpinp RO 05/11/'2000 15:57 5083736611 —..S-TEW'RT/AHDOVER P A G E. 0 2 X641 Alv): ver (2-6, 1 /Main oc"rMARTFS SEPTIC TANK SmWICE. 47 RpjLR(M RrRr Lie- BRADFORD, MA 01835 978-372-7471 Now-K OF MC*M.'Ly PUDORT FOR TCWN Op DATE ADDR13Ss GALLONS -7 ....... lAg) f r)vv/ .......... J-x L9 FORM 4- SYSTEM PUMPING RECORD Commonwe th of Massachusetts ° w „� elf Massachusetts JAN Sys I _ 10 �" System Owner System Location i Date of Pumping: ° C uanity Pumped: gallons Cespool No Yes Septic Tank: No Ye Condition of System: a System) Pumped by: Sewer- an/Rooter-Man License No.: Contents Transferred to: � Date, Inspector: