HomeMy WebLinkAboutSeptic Pumping Slip - 102 SPRING HILL ROAD 12/28/2016 Commonwealth of Massachusetts RIECEIVED
w CO/Town of
SOtem Pumping.Record
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DEP has provided this forrri for use-by local Boards of Health. Other forms may be bled, but the
Information mint be substantially the tame as that provided here. Before using Ahis form,check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility, Information
1. System Location: Left/Right front of house, Left/ ght rear of housy Left/right side of house, Left f
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
7dy—i"own State Zip Code
2. System Owner:
Name'
Address(if different from location)
Cityfrown State. ip Code ;
Telephone Number r' `K
o•
ipi ' in
1. Gate of Pumping ante . Quantity Pumped:
Gallons
. 7 ype'of system: Cesspools) ptic Tank El Tight Tank
Other(describe):
4. Effluent Tee Filter present'? a No If yes, was it cleaned? JD s No,
5. Condition of.System" {
Y
6. System Pumped 6y:
Nell.Sat on P5821
Name Vehicle License Dumber
Bateson Enterprises Inc-
Company
7. Location wh rp contents were disposed:
ISIgne S Loweii Taste lhlter t<D Mul Cate
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