HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 83 PENNI LANE 5/13/2025 Commonwealth nfMassachusetts
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Pumping
Record
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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 same au 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 DK8for0Nat~o0h
Important:When
filling out mmm 1. System Location:
on the computer,
use only the tab 83PenniLane
key m move your xuumau
cursor-u«not North MA O1845
use the mmm
key. City/Town State Zip Code
2. System Owner:
`---~ Mike Fritzinger
Nd-dress(if di ff-erent-fro-m-lb-cation)
City-1-Tow-n— State Zip Code
781-710-1131
B. Pump~ng Record
5/13/2025 1500
1� Date ofPumping 2. Quantity Pumped:
3. Type ofsystem: Cesspool(s) E Septic Tank F] Tight Tank Grease Trap
LJ Other(describe):
4. Effluent Tee Filter present? Yes No |f yes, was itcleaned? Yes No
5. Condition of System:
Good system tiproperly
G. System Pumped By:
Jason Elliott S71437orV852�7
ame Vehicle License Number
|waekar and Elliott Services LLC'DBAJason
Elliott Pum i
7. Location where contents were disposed:
BLSD