HomeMy WebLinkAbout- Septic Pumping Slip - 31 BRIDGES LANE 5/7/2019 ,� Gr St 0
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Commonwealth of
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City/Town o
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S, 'tein Pumping Record 'J'lqvl'j"'""')r
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Form, 4
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has provided this 1brm for use4by to Boards fl ' Other maybe,*used,,but the
information-
must be subst6nflally the tame as that provi'de�dheck with your
to l r Health to deterform' they use.The$ystern Pumpi rid must be Submitted to
the local Board of Health or,other approving authority,
A, F a d"119 ty I n f o r m" a fil o n
1. System Locaffon: Left/Rightfront of house, Left I Right rear se, Leff right side of house, Le
Right side of building, iglit frbnt of buildifig, Left fight rear df'building. Under deck
Address ,.
0f r, state zip C �
. Systern Owner.,
Addressi ifferent from to flo
Cityrrown if Code-s
p
W
Telephone Number
S.
Pumping Record
I. Date of PumpingDate 2.
I Type-of system:, E] Clesspool(s) eptic T,
k, Tight Tank
0 Other(describe): -- -----------
4. Effluent Tee Filter Yes 0 If yes, was it cleaned? Ej Yes No
. Condi"don of
o�w
6. System Pumped By*
Name
m
Vehicle umber
Bateson E��rlses, I
Company
. r
LowellLocat1i ere contenta wee displosedip
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t
Sl ul Date
. ,a 06/03 System Pumping Recorda