HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 55 FARNUM STREET 4/23/2026 Commonwealth of Massachusetts 0y1 In (
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System Pumping Record 44AY 2026
Form 4
DEP has provided this form for use by local Boards of Health. Other'.or4ftM,, y:d, but the
information must be substantially the sarne as that provided here. Before using S to
local Board of Health to determine the form they use. The System Pumping Record must be Wth Our
the local Board of Health or other approving authority within 14 days from the pumping date in.
accordance with 310 CMR 15.351
A. Facility Information
Importaft When
fiffing out forms I. System Location:
on the computer,
use only the tab
key to move your Adore"
cursor-do not MA
use the return Ci-y/Towr., StaTe Zip code
key.
2. Systern, Owner:
ream
Address(If different from location)
City/Town Stele Zip code
Telephone NG.mi:7er
B. Pumping Record 2pate . Quantity Pumped: ) (no
1. Date of Purnp�ting Gfallons
I Component: Cesspoof(s) Tank 7, Tight Tank 71 Grease Trap
1'7 Other(describe):
4. Effluent Tee Filter present? El Yes io f Yes, was it cleaned? El Yes 7 No
5. Observed condition of component purnped:
A
—,!! of this estimated
information is non-birldin ViLijo—rilY at the timi e of Qurr.,Qing. Not responsible beyond the date above.-
6. System Pumpgy:
dame Vehlcie License lhilurrber
J&S Development Corp. d/b/a Stewart's Septic
Service
7. Locator where contents were disposed:
Stewarts Global Environmental, LLC
20 E3 dford, MA01835
Sec- above
of Hauler Data
See above
Si,g"ature Of Raceivirrg Faciihy(or attaop,facility Ce r,. i pt) Date
t5forM4.doc-I i/I P
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