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HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 537 BOXFORD STREET 7/1/2025 y down oflVorthA Commonwealth of Massachusetts n�ov�r City/Town of . - JUL 202 _ System Pumping Record a epc nl DBE' has provided this form for use by local Boards of Health, Other forrns may be used,�utR�}� he Information rnust be substantially the sarne as tht11 providacS here. Before using Phis form, check with your local Board of Health to determine the forrn they use. The Systern Pumping Record must be submitted to the local Board of Health or other approving authoMy within 14 days frorn the pumping date In accordance with 310 OMR 15,351 -. ---- _ _-- HOUSE �dr lock side rear left rlf A, Facility Informatlot-1 8UILF)INJG frOrr7T- rack side rear left cif, Important: Whein OE CK: under NhIncd out forms 1 System l (Ofl C ,( us the yon7p ulr3r se ortl Ilia tab ' ......_... key fo move;yoerr !er reps ,.. cursor -do nol 15 MA d use Mereluln c;ii T 0,( - s' _ ke,y ystale lip Code ;> SysterrL. �v nerM y' tl ,.M1 - - - _ 1C Addroas (Ir differ©nf from location} MA Clly(Town State 6 ( 1 Zip Code Te6ephone; Nu(r)her B. Purnping Record 1. Date of Pumping O to ._ ____- --___._-- t, Quantity Pumped'. �s Gallons 3, Corn ponerit: [_,] (';esspool(s) Septic -Tank ( j -right Tank Grease Trap i� Other (describe) _-__ 4. Effluent Tee Filter present? [-_] Yes FI_ No If yes, was It cleaned? El Yes [3 No 5. Observed condition of con-ipone l purnpecf: 6, Sys[ rn 'Purnped By D vE Tif7ny Mass 1 f�95E Muss 1 AD3 1l _.__. VE:hi<,Ir, f_Icensc. Nu er is�s, Comp!rny 7 Lo aticn where c' ntents were disposed - .. Signature W Hauler )talc Slran7lune ra( Rec;eiving (-acilily (ctr allrrch (ar;ihly rr,r„csir>I) 0a1e L5(orr7r4.C9GC 1 tl1 Z yslerru Pumpinq Record Page 1 crf 1