HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 495 REA STREET 11/7/2025 Con1monwEalvh of Massachusetts Town of NOdh An over
City/T o of
System Pumping Reco� 2025
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Health Depa
DEP has provided this form for use, by local Boards of health. Other forMS n'tay be usr %
nl�ct
locarl Board i-Tiust
fie,kath t�)de ermineftl7e lorn,i lhety uf,5e. 'hePSyseter'n P rnpiing uqing form, ce su mih your
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Record rr�l.rsl be submitted to
the local Board of Health or othe,( approviog authority wilhin 14 days from 'he pumping date in
accordance with .310 C;MR 15,351 — ____.. _ _..._.
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use only thelab -`.5.._
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e do not
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B, Purnping Record
1. Dale of Pumping (jai_;-_ _---.._ —.._._-- 2 Quantity f-'(��n�1�ed' ��-
✓Gc�`rhions
3 Component (......i Cess F�;or>I s( ) Septic Tank (..� Tight Tank s Grease Tr,
[_] Other (describe)
4. E:ffIUent Tee F=filter present? ( � Yes No If yes, vJ�is it ole;:'�3m,d7 ❑ Yes (,.� No
3, Observed con(Wjon of Cornponent purnped
6 DI.� (er�"f�,F'f,mp�d By:
y Mess 1A.Ard E ass, 1AD31Z
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Baleson E-n(erp(ises, kw" �
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_oc„ation where contents vvre(e a'.1i5f,ose(A
,ignature W Hauler Dale —
rIC)nElllr n9 ry( ire.Geivl1)g F;rcilily (or @tlac,h IaCih(y receipt) fJulr°
151orrn4.doc 1111"l System fr'um ping f2r,,cord f'3Cte 1 of i