HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 186 INGALLS STREET 12/1/2025 < � Commonwealth of MasFsachusetIs
y t t-n Purnping Record
DE P has provicied this forrn for a c+ by local Bowds of Health, Other forms may be used, but (he
information must be substantially the fsrarne as that f,arovfd2d heree, Before using this form, check will) your
local Board of Health to determine, U)e forma they use. The Systern Pumping Record must be submitted to
the local Board of Health or other approving aulhoril'y within 14 drays frorn -,he pt-lrnpinp date in
accordance with) 310 C.;M€; 15,351 _._._..
I-?UIJSE: front ac. �de rear t
A. Facility ( nformatlorl BWLDING: fror)( Iaack side rear left l
Important:Whoo DECK: undfer
IIIIIng oul forms S stenyy7 l f�c;��ticrl7.
use only tiro tarts gh+
key to moon yo,i.rr ACErirr`lt;s
l':urspr -do rrot fvt Ause the return
key. Cliy[Town Sl,a( Zip cantle
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j 2L7yste3rn Owner':
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Ac7d(o:ss (If ditfe(onr ((orn k-)c,atlir, n)
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Gily(ft>wrr al .f Ip torte
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releph ne h urnber
B, Pumping Record ))
'I Date of Purnpiny ___� .....� . _.. 2. Quantity Pumped, d._� ._-.. ....
DaIeGsillor7s
r Uf ( ) ( septic Tank ( � TigJ Tank (_� Grease Trap
3 Corn�onent. (._.� Ces :roof s
4. CfIuent Tee (=iIte present? (._J rVo If yes, was it cleaned?
5, Observed concWiorl of cornpone.nl purrlped:
_.
629
y -..- urrtfrc.,ci l'�y —
(7<av i!n }( Mass 1lr,fat)5 Mass 'IAA:( Z
N in'r�, Vehicle License umber-
E��lf.sc)n � nit"'ri-�rlsf�� Inc
D(la
n w orltent,,7 vvc;,,, e dispo°aed.
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Sicnsilifra t1( il�ulr^,t _ _-
>ignsrlc(rl., cs mil.,rciv ng 4 ,,rri{ily (air cittaC;h (erility ra,a,t,il)l) fl<fle;
510rrri4.fioC; 1111'4 SYSIc rn Pumpirug Record Pap 1 0(