142 System Pumping Record 2016 ciP/P-Polics,
CornmOnwealth of Massachusetts,
pi. .City/Town Of- - . etitieht j4r1-1
Form-4
System PinTMimi cerd.-
. . . .
DEP has provided Pis forth for use*local Boards of Heath.Ober Tormarney.be used,blithe •
trgorritseon emit be ellintentlellY its WI*Ela ihat ProrldPd here Betts using gistern,diedSth your
local Board&Health to determine the Torn they a Ths,System Pumping Recordmutt he submitted to
the a Board of San or other approving auto*within 14 days torn the aping We in
accordance114th 310 OMR 15.351.
•
A. Facility information
irta ad 1. System Location:
r,um
bab key Address
cloud
K.ratun
3 ' qttwc;)_pq.)40
Na- INi)o-kot Dol
Mdiesiref Sanwa tot to.so
atinsts
CV>.
S. Pumping Record
A. Debsof Pumping (CDVI-94(4'2 L02. Quantity Pumps& th-C C
— •
pofsm P1 Cesspool(s) SepecTards 0 IlittTesk 0 Grow.TraS
other(describe), N
4. Effluent Tee Filter present? d Ves,J24o if yes was It cleaned? C Yet j2;140
• S. ercedidonsd System:
arril /14(r9C°61
Telichonerlaater
rzmwa
7. Looldioinwhete Contorts
disPoest
y Unease*Taber
*nature orReceNsig Fully
Norm4.docr OtWee SPENT Ptilipleg Reogal•Page 1 of 1