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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 21 EASY STREET 3/24/2025 Commonwealth of Massachusetts City/Town of ,^�/�� ��� System Pumping Record `' � � �� . Form �u�> DEP has provided this form for use by local Boards of Health. Other �� {} information must be nubotantiaUytho name as that provided here. Before usingihia for—.-` ur iDCg| Board of Health tO determine the hJ[r0 they use, The System Pumping Record must be »ub-"| i0 the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310CW1R 16.351 ___. `�__� back side rear left -~_~ A. Fac'|'h/ !nfOrNOaf'(]n BUILDING: front bock side rear left right Important: DECK: under �wno � o\llng out forms 1 System Locstim on the computer, use only the tab key to move you, /duress \ cursor'donot use the returnMA key, CityfTown =°= Zip Cvnv 10/Q,—] 2. System Owner Name Address(if different from location) MA City[Tvwn State Zip Code -f�-Iephone Number 1, Date of Pumping 2. Quantity Plumped. D all Gallons 3. Component: [] Cesspool(s) Septic Tank Tight Tank Cl Grease Trap �7 Other (describe): 4, Effluent Tee Filter present? El Yes No If yes, was it cleaned? El Yea Fl No 5. Observed condition of component pumped, G, System Pumped By: Oove T|n Name Vehlcle License ea�escn Enfqrprlses, Inc.__ Company 7, Location h re contents were disposed: t5fom14doc' 11/12 System Pumping Record ^PaAa 1 of `