HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 285 REA STREET 6/3/2026 Town of Nodh Ands Comn�onwe�ltf� of mass ver
City/Town of SUN 5
t System Pumping Record
1 FormHealth 4
[CEP has provided this form for use by local Boards of Health Other forms may be used,
e but the
information must be substantlr,illy the sarne as that provided here. Before using this form, check with your
local Board of Health to determine the form They use The System Pumping Record must be submitted Io
the local Board of {-Health or other approving 'W'horiiy within 14 clays from the, purnping date in
accordance with 310 CMR 15.351 _- ___------
A. �c�Clfl� Information --- -- --- w3l}JIt�oINC���. Er�o a is I' r-ifi�. br�tcl<, slde rrr7r Irf`t} rif;h t
nt k»ck side rear eft right
Important;When (BECK: under
rinlr,g out forms 'I. System Location:
on the ccmpuleyr, _,I °
use only the tab
key to move ycaur Address
cursor-do notf '
u e the: return — _-�_ _ .___-._ _.__ _ __,., MA f�
CilylTawn _ _ ..._.._. —. --_-_ __...-_._
key. -7131e Zip Code
(� 2. Syst,rn Owner:
W
t Name
--------------- ------
MIA
c c foss (if dif(erpni from location)
-- — _ - — M A,
ityrrown t31
Zip Corlra
felr�phcrrre NurnbEr
F3, Purnping Record
1, Date of Pumping �`? `'- _.- -- 7 Quantity Pumped.
Gallons
3. Component: [ Cesspool(s) Septic Tank Tighi I"ank C� Gre, Trap
(� Other (describe): -- ---._._--- - -------------
4. hffluent Tee Filter present? Yes E-1 No If yes, was it cleaned? _] Yes (_] No
5. Observed conditl-n of component pumped:
6. Systen-i P(,fmped By:
Dave Tln�Y_.—___.----_----- ._ Mass 1 9�E Mass 1AD31Z
Var1)f;
\/e;Y�lt Ir' E ine:ng� �7urr'lYar�r
eakeson Cnfer rises, Inc,.
Compny
7 L. o�n where Contents were disposer.f:
G�SD
--..
- -- --- -- _.---
"gnaturr,� f Hauler [MlC — --
signature of Rr-celving Facility or a(iir.i facility rcceip.) 1e —
t5ftarr»A.r1oc 11112 Sy.stern Purnping RoCD1d Page 1 of 1