183 System Pumping Report 2016 t Commonwealth of Massachusetts '
i City/Town of ,
s' - System Pumping Record -
Fom' 4 -
. . i DEP has provided this form for use by local Boards of Health.Other Tamp maybe used,but the
Information must be substantially the same as that provided here.Before using this farm,dedcv
local Board of Health to determine the fonn.they use.The System Punning e date is
Record
the local Board of Health or other approving authority
accordance with 310 CMR 15.351. ,
A. Facility information
Importenrt
Men Ong we 1. System Location:
tom's on the
. - c mputer,use
only the tebksy Address , .
- -
to mote row. - . .
-
uesor-do not - Cltglawn State Zip Code
use the realm
" 2- System Owner: - -
� , C Sc- we7TER
Tr3 ?Tt9LC CL,D G-€ Ro
Matbes'(edlRemtd from looatla')
Ckysraan . State ap Cale. .-
•
- -/ kOZ.E611 (- T .
B. Pumping Record C
` A. Date.of Pumping - l t,2. Quantity Pumped: luoO asjons
3. Type'or system: p Cesspool(s) ��`-'/Septc Tank El light Tank ❑ Great
❑ other..(describe): l-C67d)�HfU(dIC'itTr ?rump-&, I r+*IKFi Dies
1.6-is..as i-0.10)4o/
4. Effluent Tea Fitter present? C Yes o 14 yes,was It cleaned? .ID Yea,
- 5. Conthtion.ofSystem:
Geon-TmE-S-WE IBS 0-cco ei) q"feS. ) N6 Ft L-0
307bp— kge-rZro, -
6. Mrrile BY � �� �
='r/ � s, Stilt G h b/k✓ eirt . Vehicle lkaresMmber _ .
7. Location where contents were disposed:
1—\ SR,
Sinner of Hinder
Moneta°of Receiving Fed*
pggrm4.doo-03106 - - SYStem Pulnpua Rao