HomeMy WebLinkAboutSeptic Pumping Sliip - 24 Carlton Ln - 11/4/2024 - Septic Pumping Slip - 24 CARLTON LANE 11/4/2024 Commonwealth �� K8 Massachusetts
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System Pumping� Record
Form
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the some as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 31OC[WR15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 24 Carlton Lane
------
key to move your xoueoo
cursor do not
NodhAndovar MA O1846'6GO3
use the return
key. City/Town State— —'Code
—
2. System Owner
�—� Sarah Tower
Name
Address(if different from location)
6it—y,�fo—.n Zip Code
978-807-702
B. Pumping Record
1. Date of Pumping 11/4/2024 2� OuantityPumped� 1500
Date3. Type ofsystem: Cesapoo|(n) Septic Tank Tight Tank Fl Grease Trap
R Other(describe):
4. Effluent Tee Filter present? Yes No |f yes, was itcleaned? Yes No
5. Condition ofSystem:
Good, system o d |
G. System Pumped By:
Jason Elliott S71437orV85257
Name Vehicle License Number
|weabar and Elliott Services LLC-DBAJason
ElliottPumping
7. Location where contents were disposed:
BLSO