10-1-01 Farm 4 -- System Pumping Record
Commonwealth of Mossachusetss
: Massachusetts
System pumyina Refar'd
System owner System Location
Dean K.rnw,00d Country Club K�rnwood Country Club
1 Kurnwoad Ava 1 Kernwood Avu.
�alwn. MA 01970-1653 Salaur. MA 0197D-1659 ,
1978) '45 7389 (9�8) 745-1.10
Type: Emergency Routine
Cesspool: No Yes Septic tattle: No Yes Ea
Date of Pumping: Quantity Pumped Gallons
System Pumped By: Wind Rivrr Environmental, UL' permit 7f:
Contents transferred to:
Contents Disposed at:
Date: V U k Pumper Signature: Dot m
Condition of 5 Comments
STAA`otJ bowylJ
1 �
PAVED
Dep Approved from - 12/07/95 <,
DC; 1 92001
CITYHEALTH DEPT^
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