HomeMy WebLinkAboutSeptic Pumping Slip - 11/11/24 - Septic Pumping Slip - 32 CRICKET LANE 11/11/2024 L[]nimonwea|fh of Massachusetts
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System Pumping Record
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DEP has provided this form for use by local 8D8rdS Of Health, Other forms may be used, but the
information must be substantially the same as that provided here. Qefore using this form, check with your
>OCa| Board of Health to determine the form they use. The System Pumping Record must be aubm|tted h7
the local Board Of Health or other approving authority within 14 days fro0 the Pumping date in
accordance with 310CK8R 15.351,
ec side rear le
HOUSE: front g-a h
A. Facility Information BUILDING: front c side rear left right
Important:When DECK: under
filling out forms System Locad
oo the computer,
use only the tab
key to move your Tess �
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use the return
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2. System Owner:
Name
MA
elephone Number
1/11/2 1 1
I. Date of Pumping -L - 2, Quantity Pumped-,
Date
3. Component: 77 Cesspool(s) Septic Tank F7 Tight Tank Grease Trap
0 Other (describe):
4. Effluent Tee Filter present? 7 Yea b No If yes, was it cleaned? Yee D No
5. Observed condition of ponentpumped:
8, System Pumped By:
Dave T|n
R te50 Ente-rPrises, Inc.
Company
7. Lo tion where contents were disposed:
0 nL1"
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