HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 60 SUNSET ROCK ROAD 1/28/2026 z x:. C.;c�n�monvveafth of Massachusetts=`t y pity/Town-7 of
y t n Purnping Record 2026
DE P has provided this form fitly l.rser try locL;I Boards, of f-fraith O4h1c-P M a�P ", bul the
information must i')e substantially the same, as tt�mt provided here, Before usir ck with your
local Board of Heal(h to detc rn')w)e th(? fcrrrn Ihey use. T he System PUr�npin(_) Record rrlust be submitted Co
the iocal Board of Health or cuther r�31.1f�1rr:rvirr�( r-31.rlflority within 1u1 days from the pumping date it
sltcord�nc,e with 'r 1O CMf'
HOUSE ®ro back side rear
A. Facility Information BUILDING: front back side rear left rlf?,N
important: Whun DECK: 6jnder
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B. Pumping Record r
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1. Date of F>umpirc3 �.. Quantity Pumped
Gailorrs
3 Component tic __. Trap
fSr r ; asN
�...__) Other (describe)
4 Effluent Tee Filter Present? E Yes A1,11 If ire,s, was it cleaned? 0 Yes El No
`3. Observed condition c> rtr7rnpon.�r lar,irnped.
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Name
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