HomeMy WebLinkAbout0020 TERN LANE - Health 20 Tern Lane, Centerville
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No. 42101/3 ORA
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LOCATION _c2 0 SEWAGE #
N TLLAGE (2"fiVl ASSESSOR'S MAP &LOT o
INSTALLER'S NAME&PHONE NO.
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SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) _
NO.OF BEDROOMS of
ABUILDER OR OWNER �0QG- 1," r2Q
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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PROMPT HICKEY SEPTIC SERVICE JOBPHONE DATE OF ORDER
PROFESSIONAL P.O. Box 2078 4999 0 3/16/0 0
SERVICE TEATICKET, MA 02536 JOB NAME/LOCATION
(508) 7FAX( ) 0-7650
508) 540 3097
TO Joan McAuliffe
........ _......._.. ....
........ .................. ... PHONE
20 Tern Lane
.... ........ ......... .. .. ..... _........
ORDER TAKEN BY
Centerville , MA 02632
TERMS: PAYMENT DUE AT TIME OF SERVICE
DESCRIPTION AMOUNT
>........ .. .C .S. Gu..�..'.............DIC.i>].._........../klGT..._..............llC ..r?.. _/�'_
Maintenance Pumping........ ez w c.cY........... .._
....... . ........ ......................... .............._.. .......................-. . ............ ......... . .......... ._ ........ _.. . ............. ...._........ .
Approx gallons
..... ..... .....
. ......
. ............ ... ........._ ' ... ... ..... ........... .
.............. not exposed.
0
.. .. . . ...... ... .......
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LABOR HOURS RATE AMOUNT TOTAL MATERIAL
TOTALLABOR
WORK ORDERED BY DATE COMPLETED TOTAL
i'• LABOR TAX
PAY THIS AMOUNT i
`Thank`You —�---
SIGNATURE(I hereby acknowledge the satisfactory
completion of the above described work.)
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