HomeMy WebLinkAbout- Septic Pumping Slip - 102 SPRING HILL ROAD 9/10/2019 Commonwe' Ith of Massachusetts
City/Town of
F
System Pumping
Record
Form 4
DAP has provided this or use,;by local Boards of Health. Other forms may,be,*used, but the
n a on',w must be substantially the tame as that provided here. Before i
ng.this form,check with your
loeil Board f Health to determine the f use Pumping b t
approving
the local Boarid of Health or other
A., Facility Infor t
'. s Location,. L Right front f house r o�' house,
� � �side
house,, Left
Right side of building, Left Right fr6nt of buy 'iris, Left Right, a uUnder
Ad&"s 7z::
ti
V*'e' a�
O /Town Stag Zip Code
2System Owner.
Name
Addmn(if different from locaflon
C own .
--------------
Telephone Number
.B. Pumping Record
., Date of Pumping Qua Pumped:
Gallons
3. c,TaType.of system.,, Tank "ank
Other(describe):
M
. Effluent Tee filter present? No If yes, was it c eanied'? W No
5. Condition of System.
6. System Purnped' By:
Neil. 'n
Narne Vehicle License Number
tes n EhLe2nwses Inc-
company
7. Lo contenta were disposed.
LowyWater11
SignAwle Hu Date
o System Pumping Record Page I of 1