HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 162 BRADFORD STREET 5/29/2026 ° air
ndOVer
�4
Commonwealth of Massachusetts
JUN 16 2026
r ,,M City/Town of
System P�� r-nping Record
Form 4 ,
x4 `
(:)EP has provided this four for use, by local Bo,.,Prdrr of I-irTalth. Other forms may be used, bul th(2
inforrnation rnust be slabs>tnntlally tl)e s lrrrrr are CII£tt C>r vidrri�d here E1eforF, using lhfs form, 0et;k wilts your
local Board of Health to r,eF errnine the form fhe,,r use `("t1r�1 System Pumping Record must brr ubmitted Ira
the local Board
ce with 3
Boar f Health,r7 f or tothei approving ,h�rovine aucrri m m
will-rin 14 days fro the pumping date in
accordfrrrrr cV F rido r(-,. I=tf nght
A. Facility Information - � falls-DIsr1G front knack sidc ie.� Pt n l,l
Important: When DECK:
fusing out f0frns 1. Syste'r-11 L_r,1r,;r1Pi41r�.
on the corm.uter,
u only the tab
key to move your Ad(trn r
cursor-do not P ,
use the return -- _.....__.- V F _ 0
Key. City/Town Siafe Zip Code,
2. S y s t e r 7 0 w n r,r
-�arne
Addrrr,s (If different from IOCMiOrl) _.._
M�
_.....-
<,it (l own - - _
Y �M;�Ir; Z.ip Cade
_.
TclrpPiorle du'r P r,r
B. Pumping Record
1 Date of Pumping __.._ _A .. _ ------- 2 QuantityPure.} f:�ct
r)alt' Gallons
"v. C(7rTr 70ner f.
Tight Tink Grease Trs,aP__ Ce;bpcol(s) Se
Ea Other (describe) _.._ ._. .
4. Effluent Tee filter present? Yee } c If yes, vv< s it cle 7nec7 -_ Yes _
S. Observed condi(jor of coinponnnt purripecl:
6. System Purnped By:
Dave `f'Inrey Msa as `1.t/ F\9 Mass 1AfU31Z
...---._..— — -------------
Name vehlrlf, IJcen,,,e- N )mI)er ._
eateson Cnkerprises, inc.
Company
7. on where contents were; disposed.
�LSL)
Si na �-
y �� H1, user )r,+le
SfgncgIurr,, of ReceivIng f ac;Hity (or allach facility r<!(,elf,r:) Datc
5forrr4,dor. 11(12 Syratern f`"(()Ping RP.conJ - Pane 1 of 1