12-4-01 Farm 4 -- System Pumping Rgcord
Cammonweolth of Massaclusetss RUCERIVED
Massachusetts
System Putwino Record DEC I 9•2UU1
CITY OF SALEM
HEALTH DEP
System Owner System Location t..:.'
0,�n Kernwoed Country Club Kernwood country Club
1 Wrn%^Ud A— - 1 Kerw-,o� d Avv
Salett, FIA 01970-16°) S51e¢. W, 01970
1"81 745_7289 19781 :'95-1310
Type: Emergency Routine
Cesspool: tdo Yes Septic tordu wYes
Date of Pumping: Qua" Pumped.,D ll
System Pumped By: Wind Aw Emi onmentn/, LLC Peredt#:
Contents transferred to:
Contents Disposed at:
Date: Pumper Signature: —1 L
Condition of Sy Comments
Dep Approved from - 12/07/95