595 Pumping Report d!!//P- 490U-a.
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Commonwealth of Massachusetts
r City/Town of - �i- li ►N.
r1 System Fum{Ping R (3-econ
Form 4
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DEP hes provided this form for use by local Boards of Healtl o>r>et tdmp may be wed,but the
tr
� ofalsubtend*the alcOle au third Provided Redie-form,chedcrolth ro
Board of the u IMSY sPunpingecodmistbe submittedto
the total Board of Health or other approving auglatty*Rhin 14 days flan the pumping date In -
accordance with 310 CMR 15.361.
A. Facility Intorrriatlon
oa 1. System Lacadon:
tons on she.
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woof-do not down• owyon. M, monde •
urn tn.non
;a. y, �"n5-95 COLISSYnggpcau Poi .
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B. Pumping Record
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: .- k �. avandly Fkinpe& , lm
9. Type:Of system: • C Cesspool(a) ....alepacilank 0 Tight rank 0 Drama Trap
9 - cum 9I Th�NT_ cU 1Pc-
other.(describe):
4. Effluent Tee FNter present? ❑ Yes No H yes,'wm It denied? ❑ Yee fl o
5. Conddon.of System: r - - .
( 1J EWA CN4R12A \tea( 7rIktz,-
g. . ```` pC1101ped By .
V�� Mikis tame!Maw .
C 1stit wok.
7: Lomeon where contents ware kasPossd: «
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