HomeMy WebLinkAbout- Septic Pumping Slip - 7 FULLER MEADOW ROAD 5/1/2019 Ith of Commonwea
Massachusefts
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*ng Record
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, Pump
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DEP has provided this form for useoby local Boards of-Health. Other formt;may,be*used,but the
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i must be substinfially the ta,me as that provided here., Before using.this'form.,c'heck with Your
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io,c�61 Board of Health to determine the for M' they use.Tbe.System Pumping Record,must be i 1
ttel to
the local, Board ofHealth or other approving
A. Facllitr InforMation
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1P System Locatjon: L,eft 11 ront of houis Left/R! ht rear of house, Left I right side of house
Right side of building, Left Right f�1111=61 building, Left Right rear df
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Addy
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State Zip Code
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Owner:System
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Address(if,different. from location)
i '� State' Zip Code
Telephoneum r
Pumping
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Date Gallons
Date,of Pumping 2. Qu6nfity Pumped: -----------
Type-of system: 0 Cesspool(s;) O"S ptic,Tank Tight Tank
Other(describe):
4. Effluent Tee Filter present? Yes If yea, was it d ? Ej Yes E] No
6. Condition,of System
�•�,•«. ' p� w� .,. ��r,"�' � mow„
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System6. � .
Neill.
Narne hide License Number
Batesion " rises Ina
Company
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" WasteLowell
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8 .. a Hhu� l .... .. ,
Date
tftrrn4.doo&08103 System Pumping Record Page