14 CEDARVIEW STREET - SEPTIC RECEIVED 08/25/2016 02:02PM 9787450343 Salem Health Dept
08/25/2016 13:57 9782814869 WINDRIVER PAGE 02/03
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Commonwealth of Massachusetts Farm 4--system Pumping Record 626"
Massachusetts
System Pumping Record
System Owner System Location
I,amarre Grace Primary Home
14 Cedar View Street • 14 Cedar View Street '
Salem, MA, 01970 Salem, MA, 01970
(978)-745-2295 x (978)-745-2295 x
zamarre
Type: Emergen Routine
Cesspool: Noyes Septic Tank:
M No Yes L�
Date of Pumping: �, Quantify Pumped: Gallons
System Pumped By: Wind River Environmental,LLC Permit
Contents Transferred to:
Contents Disposed at:
Date: Pumper Signature:
�-
Condition of System/Other Comments
Crc'�
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Ipswich, Mk
® Rvnmonrecva�acroa Dep Approved Form-12/07/95 ....._-
08/05/2015 13:43 9782814869 WINDRIVER PAGE 02/03
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Commonwealth of Massachusetts Form 4-System Pumping Record' �C
Massachusetts
System Pumping Record
System Owner System Location
Lamacre Gracc Primai:y Home
14 codar View Street 14 C adae 'Views Street
Salem,: MAS 01470 Salem, 10., 01970
(978)-795-2295 x (978)-745-7295 x
tamarra
Type: Emergenc z Routine
Cesspool: NoF/ Yes Septic Tank: No Yes
Date of Pumping: -- r �} Quantity Pumped: Gallons
System Pumped 8y: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
Date: `-' ` Pumper Signature: I1A1�
Condition of System/Other Comments
-19 Dep Approved Form-12/07/95
D&G Septic Tank Service 5 7
327 Asbury Street Date:
S. Hamilton, MA 01982
U `'sn L
978-774-7491 Technician: Ly
CUSTOMER SERVICE REPORT Hose length:.3y
System Owner: rac c Lc tyN e cAr Job Site/Contact:
Adess: 1'-1 G/ /i C' S a Address:
tIPr , IV
Phone: Phone:
S STEM FUNCTION CHECK & PUMPING REPORT
Septic Tank: ETsingle ❑double compartment Filter present: ❑Yes Zl No
❑ Cesspool: ❑overflow cesspool
Size of tank / r0O El Cleaned ❑ Replaced ❑ Installed
gal Type of filter:
Actual amount pumped 1500 gal Condition:
Scum layer(acceptable range 1-2") 2 " in
Sludge depth (acceptable range 5-10") y '/ in Comments:
Liquid level 4-/ ' I/
❑Overflow Tank / ❑ Overflow Cess ool
Size of tank gal
Actual amount pumped gal
Liquid level
Condition
YES NO
Tank structure We recommend that you pump your septic
Breakout or ponding system every: 1 G 3 4 5 years.
Liquid level above inlet invert *Thank you for your continued patronage, we
Liquid level above outlet invert really appreciate your business! Our goal is to
Tee or Baffles missing or broken inlet leave our customers satisfied and delighted by
Tee or Baffles missing or broken @ outlet providing exceptional service. Please call with
*YES indicates there is a problem,NO indicates there is no roblem any questions or concerns.
PREVENTATIVE MAINTENANCE PERFORMED
QTY. DESCRIPTION PMTC-F, AMOUNT
r
TOTAL /
Payment amt received $ 1 0' 00 ❑ Cash Check #19 11 Bal:
For office use only please. 9 Invoice entered 24Payment applied Pumpin report sent to BOH r
Date: _�� Date: (#I ��_(�� Date:_
� e
W(� Please call with questions/concerns
PM M Mmgm We appreciate your business
Septic System Function Checkand Pumping Deport
Property Owner's Name: �to ep— LP-M
Property Address:��r.�l�� 8� ��� �
Date of Pump/Function Check._5 /��/Q _
Routine: Emergency: [I Technician__
`
SEPTIC TANK SYSTEMSingle Compartment ❑Double Compartment
*YES indicates there is a problem, NO indicates there is noproblem
Tank structure YES NO
Breakout or ponding
Liquid level above inlet invert
Liquid level above outlet invert
Tee or Baffles missing or broken P inlet
Tee or Baffles missing or broken outlet ��It
FILTER PRESENT ❑ Yes No TYPE:
Condition:
E]Cleaned 1 l\
0 Replace
nsae
o
0
TANK LEVELS AND MEASUREMENTS AUG 14 2006
Size of tank
CITY OF SALEM
Actual amount pumpedXNo
BOARD OF HEALTH
Scum layer (acceptable range 1-2")Sludge depth (acceptablerange5-10')Liquid level
OVERFLOW TANK PRESENT ❑Yes
Size of tank
Actual amount pumped
Liquid level
Condition
COMMENTS: