HomeMy WebLinkAboutSeptic - Septic Pumping Slip - 502 WINTER STREET 12/18/2025 �._ Commonwealth of Massachusetts
City/Town of
:(. y stem Purn in Record r d
� y � �
` Farris 4
Q. .
DEF1 has provided this form for use by local Boards, of Health, Other forms r-nay be used, bui the,
inforrnation rnust be:; substantially the sarne as th at provided here, Before using this farm, check with your
local Board off Health to determine the forrn they use. The System Pun-aping Record must be submitted to
the local Board of Health Of other approving authority within 14 days fron-i the purnping date In
accordance with 310 C MR 1' 351
SOUSE_; f ent back side rear E,hr.
A. FacilityInformation t31.1f_CDING �rJnt backside re heft rltht
Important: When
DECK: tjnCfe:?r
(Ming out forms 1 Systr f I C)C 1tICM
an lhr>cornp)utor, � )L.
/"� (
Lase only lho lab � ��, . _..... � ._1� 4
key to move yow Address _..._
cursor-do not PUTA
use the return _.._.___._ r_._ �I l- ��.___,. .
key, €;ityf-rowo ✓ -- state Zip Code
4 ..__ 2 gay. eM 0wnesr�.
C ____ __ __ _ . __._
N<{!ne
Address (if ditferlent from location)
MA
c;ityrrown S t a(e.
T'e(cpflrr c• I,rr 7e.r
B. Pumping Record
i, Date of Pumping _.._ _ _..._-- 2 Quantity Pornped /
Taira GaTons
3 Component: [_] Cosspoo)(s) eptic .Tank �..�7 Tigl)t Tank ❑ Grease l-rap
Other (describe) _ .. ---
4. E ffluef-It _f.e;e f ilter Present? (_,J Yes [�__ Nr if yes, was it cleaned? E,] Yes
5. Observed coo dition of cornpone;nt pur
System f='rl -ipe� �1 ByDav
_...__. q M as 1AA95P Mass 1AD31Z
� t�l8¢'ItF VLY'71c1 l_iCc r13c Number
Bateson ntesrprises Inc
7 Locati.'it where fte its
GLSU
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,�igrr<alnre of f-laull.,( (.lfata
_.,.
,ittn£7lrlre of Edl-:c.Hiving Facility (or <,Itach fnl;illry recE.11>l) _ r)tsCr;
>form4.dcr.; 11('11 Sy!;tcrrn ilurnping Ftr3corrl Caaa 1 N I