HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 125 WINDKIST FARM ROAD 3/7/2022 1010
Com monv� alth of Massachus ttq �P�oA 6� �10
a4r/Town of c)Ctn Rndov e 0� ��
�F OR;� sRecord System Pumping 0
QP
3' FOrm,4
DEP has proVided this farm for use by bee Boards of Heam,Other fours M
ay be U01gd,JUA the
inIbrmation must tre sub�tanjaffy the same that firOvii i herd,ire Uft ING IbM the h your
kxsl BbWd of Health to determ the ford fty Lisp,The$yzlem Primping#biro trust subml"ed to
the local Board of F10a1th or vitt approdhqthu">i in 14 d"s fkom owni rin
ap.10r lance with 310 ChIR JS a6j.
A* FACI iY In soon
imporbotu When
mgr,§r f Rns 1. Systiem Locatio%n:
on the c o ter, !'' V v ryl
l
use 0*jW tab
key to give ynur MOMScomor-do not
yl,I it IX
f L/
may, cftyrrov n t i
2, System,Owner. _
.. p3nI, •,... ...,.,.,..:.ate,..,,..,... .::...� ... :: .,... +.- �,.
B. Plumping Reoord
I Comp<awt 11 cess . ks) Y t o Tw*
Other(.describe):
4. Effluent Tee niter prasent? rr f Yes, 'l if yes;was it deanW, j Yss No
5. Obse.yeti tohdifiOn of 00M- pt rtt pmi is
6. Syste Pumped ley„
Name Ugeme laumbo:
cdmpany iltiziv t �1:
rtl;R $,
7. LoCabon where
i3
S;gr= e ` bit-,
:grata of Rece:LIN ForMy for each Dili y ceceipi Onto
F��ri�:ctoc i#132 -
SylsitrYi ftt# d*A a sf ti