HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 305 ABBOTT STREET 6/2/2026 Town fa
rth never
Cor1"lmonwea- tf1 JUN
15 C i t y C>w f1 2026
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System Purl'� pmg Record a/p
L
Form 47,
nerlt
DEP has provided this form for use by local Bowds of f-ir,,ajtl�a Other forrr7s may be use(i, but lf)e
information
oard must
of Health substantially
he me a}ar,t�lat ro lick d h(�t(n, Bflfore using this form, check wiH) your
determine,locato `:';yste rn Pun-iping Record must b(� c,mbf'niIfe ) to
the local Board of kinalth or other approving aufhorily within 14 ri'ays from m the purnping rlato in
accordance with 310 CMk '15 351
II-)LJyf_ fr()T (ack ridr, rm)r t,_, ri'fi�„�
c _ fronC hacI< if. leas Ief_t
�,. F�rllit.y Ir)fc�rt�r���ti<�r� k3t_ru.l,)itvr_, ,i,l
mportant: When CI C.I< Ur14'ie
01hrig out farms 1 Syst(;err1 l_or allr7n
on Hlo r ryorrrfyula�,,
ordi '
sac cr Phr+ (aP7
krvy Cry mova��your tie}rirr�
ur rx -do rrol m A
usr, the fetuuy
ff own
�— ? B stern Owner:
_� S .0
Name
�frlirrt
Addmss (if different morn location)
MIA,
C,ityfT"own s! fide Z� Code
......
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Telr;phone Nun7t�r:r
.........______..
E'er. Pumping Record
1. Date of Primping Quantily Purnpr ci
C)aIes Gallons
3. C)orTaponent Cesspooip) 4" Se p t i c lank �.._) l icjtrI T a n R ['7 f;r�asc 1'r,p
�.._.� Other (describe)
Effluent
�. Tee Filter farrr;7r„±r7("r ) Yes �._ f�la If yps, wns it r,{w�-inF,c`4'7 E._� Ye,s �_� No
5, Observed condition of cor)nponent r , �npecl
f
6 Sy CTI
rnpe(.J By
Da1 M a s 1/V\�)5E Mass 1AD31-
_...
e I icnn,;,r,= tJrur'i t_Cr
Gakeson Cnferprlscs_ inc.
Company _
7, l ocation wllef onCs ,were uiSp05C(I:
_.-__.
Signalurra o(4lstilnr ()a(c
`ignalufe c)f R�ec aivhvj I �rr,ili(y (or allachi (ar,ility receif)t) a(C"
t5forrn4.do<r II/Q
System Pumping RpcbrC9 �Pj(1c 1 ()i 1