Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
System Pumping Record 11-17-17
RECEIVED 12/19/2017 04:09PM 9787450343 Salem Health Dept 2017-12-19 12:07 TROT-Newtown 2034260067 » 9787450343 P 112 >,.t;�f111Ttbf91ak1}ks .re M«..wwrN+wo�1N.i City/Town of s' System Pumping Record Fornn 4 REP has provided this;form for rase by local 809tds of Health.Other forms may be used, but the information must be substantially the some as that provided here. Before using this form,check with your beef Board of Hoeft to datormina the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 16.351. A. Facility lnforma#ion imCottant:Wtren We outdone 1. System Location: on the computer, j UN only a,o too .,....- ,.,.._.. .r.I„. j..r�s '.. ` koy to more yotrr Adtlroee - ...._�._._..,.._............_. ._..-..... ....._.�._._-.»..._..._..,_....... cursor•do rat V >ne rahrm 4ityi`fdwri .... 1...._,,._.�.__._.........�. MA ..._.._...,..._____,.. /, .. C ___.- ��,rr�--,, Zip Cogo VQ 2, System Ow ffner: Name Adaroat"trcilNfarent c;� T®lephono Number C�. Pumpinq R— ecord 1. bate of Pumping -tom 4- . 2, Quantity Pumped;Doe -� 3. Component Cesspool(s) 1Z Septa Tank 0 Tight Tank ❑ Grease Trap 0 Other(describe): 4, Effluent Tee Filter present?,Q Yes 0 No If yes,was it cleaned? Yea © No 5. Observed condition of crJ nsnt pumped. 8. System Pumped By; Noma�_..,_,..__..__.n......_-_,......„„r.. Vahkra Lkanea Na�`_ "•-•^—__.......„,.._._. Wind River Errv_trr8mental awwry - _-._.._.......,......_ 7, Location where contents were disposed: abna•--•lure or t!uttr ..,.�_...�.�.„� ,_--�^— 'boss� _.._....�.._ sbmttweaiRoosirtn®FecL._..�...�.�..•.."..�'.._..,- kytar anach taoaty ro«rwti seta T..µ..•._---...._.__........._. *Wm4.dw 11N2 syetom pompolt Raooad.Ail"t of t