HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 95 CANDLESTICK ROAD 6/5/2026 (tea C o r1'1 ' JUN
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Systern Pump g Record Heal
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� / Form 4 epartm jryi�
DE P has provided Mis form for me by IocW Boards of Health Other forms may be used, but the Alt
inforr'nation must be substantially the same as Visit provNe d hoe. [3rfore usir)g lids form, with your
IoCW BoaW of t-1e,2kh to determine Te WTI Ibey We He System Pumpinc-a Record must be sf.lbrniW?d Ia
tfte IocW Board of Health or Crtraer <=ff:pmvkg Whority wilrtin 1 rl nays from, Me purcapNg c1w lrt
accordance with 310 C MIR 15.351
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key, alytravr i^i Systnrn Owner
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/\cfcfrca.,s (if dilfF rr,ril from Ioc�+li�>n�)
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Cety/'1'avert _ �lr
Tcl o on NJnber
. Pt.art7f�lr7g r��carci
1. Dam of Pumpin -__ _. ___.._._-.... 2 QuanW Purr 'cl
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3. Componenr WSr,Pool(`) ;>r,f;atir., 'rank. �_�_� 1"ighI Tank
[ ) 0 her (describe)
A. Effluent lee hiker grease M? (._] Yes If yes, was it cleaned? o
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a.
r Observed conditionof cord{ irtl (wrnf>ecl �
6 Syste pe,d Fay:
Dav I FIneY,_ _- Mass I AA95 /fvlass 1 AD31
Name Vr.ttlt'.I r^ I iC.t_ng t°p t,1ur'nb6,r
C3a� �n Cnlerns�s inc
C'ornfaany
T 1_(oc W to where cQ.feNs we e Mposrod
,.,Ir�naluec:a er(41�:3uler ()710 ,
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`l Pt,m Ream � age 1 of 1
YSforrn4,cfcrc 1 ern alrx 1(11 � �°' G .� P