HomeMy WebLinkAboutSeptic Pumping Slip - 32 Deer Meadow - 10/31/24 - Septic Pumping Slip - 32 DEER MEADOW ROAD 10/31/2024 [[}mm[}[]wea\fh Of Massachusetts
/`'fy[T[)yy[l of
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health, Other forms may be used. but the
information must be substantially the aome as that provided here. 2efora using this form, check with your
local Board of Health to determine the form they use, The 8yatorn Pumping Record must bo submitted tn
the |DC8| Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310CK4R 15,351. —
A. Facility Information BUILDING: front back side rear !eft right
Important: When DECK: under
filling out forms 1. System Locotion�
nn the computer, �w [
use on�motab
key to move your Address � ------���—
uvmo,-donot (
NIA
use the return "
key, CityfTown =°'° up Cnnn
2, System Owner:
Name
rent from location)
K8A
B. Pumping Record
3. Component: F7 Cesspool(s) �� Septic Tank F7 Tight Tank Grease Trap
F� Other (describe):
4. Effluent Tee Filter present? E Yes No If yes, was it cleaned? Yea No
5, Observed condition of component pumped:
8, System Pgrnped By',
DavaT/n
wamo vemcle Licensewu
Bate Bateson Enterprises, Inc,
Company
7, L 'on where contents were Ll
disposed:
LSD
ignature of Hauler Date
t5fonn4.duc' 11M2 System Pumping Record 'Paq* I of
`