HomeMy WebLinkAbout- Septic Pumping Slip - 295 REA STREET 6/24/2019 *. I �r�rrr�r�r� ��rr�(� �'�� !i
Commonwealth of Massachusetts
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Cfty/Town of
systetn Pumptng Record
Form 4 T(VtJf,`4 01' 00f
DEP has provided this form for useqby local Boards of Hl,ealth. Othe!r form maybeused,but the
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Information- providednth your
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the local Board of
Health or other approving
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I System Location- L ft/Right front of house, Left MQ rear hous. Left/Aght side ofhoulse, Left I
'�Pb I deck'
Right side of building, Left, Rig6t fr6nt of buildirig, Left Right ia-Trd' uRdIng. Under
actifty InforMation
Address, q
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OWE State Zip Cody
Systemr
Address Of differentfrom location)
City/Town Statq Zip,Cod
Telephone Number
Pumping
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ecord
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11. Date of Purnping
Da(P 0% At*%
te hone
-00004
3. Typ&of systern: E) L iTight
Other(descbe),
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Effluent4. If yes, was,it cleaned? es No
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Condition5.
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System Pumped By:
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Name V icle LicenseNumber
Bateson Ehterprises lna
Company
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S Hhulle Dam
ib ,06/03 Sys Systern Pumping Kurd Page