HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 90 WINTERGREEN DRIVE 11/14/2025 TOWn
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Commonwealth of Massachusetts
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System Pumping Record
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DEP has provided this forrn for use, by ocal l3oaids of Health other forms may be used, but the
nforrnralion ITIUSt be substantially the <sarne a;> thlaf t")rovided here Before ur,1n0 (his forrn, chock wilt) yow
local Board of Health to deterrnine 0he form lhey use The System Purnping Record muss be su. )mitred to
the local Board of ldealth of oIlhef at:rpmvmo aulhofity within 14 days from) '.he purnpinc) date";in
acco(dance with 310 CMR 15 3,51
fIC�t.1SF: front h sic side re4�r " left� If;Sit
A. Facility Information 8UILC)lNG: front back side rear ief-T fight
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B, Pumping Record
1. Date of Pt_rrnpin<; ir.. . 2, Quantity Pufnped'.
Gallons
3 Component. (^_.} r,',essperal(s) Trap
l "Septic 1�ank ic.t'ri Tank
3 FJ C3reasTrap
Other (describe):
�. Effluent Tee Filter present? (" -rr ❑ NO If yos, was it c,Ieal)ed? (�'`` es [_� [vIo
5 Observed condition of con-ip lnent purnpecf
G S stem Pumped By
-- s 2av Mass tfF95 Mass
V�rrrt VehiCle t_Iceme N irnbet
Balesorl Enterprises, Inc,
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t " CiCrr"1 whIerE? c'1nte(its were; (11rfao4'stlrtJ�
sit�ntaIum (>t..iIauIer _ --
t)atl�
nnlurr o( F cc -lvl1rg f ac iIily (or HttaC) facility r(;t: ipi ato
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