11 CEDARCREST AVENUE - SEPTIC Commonwealth of Massachusetts Farm 4--System Pumping Record6.2, 0,4
Massachusetts
System Pumping Record
System Owner System Location
%lail,at. r> David k%y .mkt^„f T-ii,me
;U cedcic Cl:txxt .A.,,,�:mkue 11, C&,;UAr Crest
5.a7.eo, KA., 01 70
at r'0
Type: Emergen Routine
Cesspool: No bid Yes septic Tank! No yes®
Date of Pumping: �l —•`� Quantity Pumped: CUD0 gallons
System Pumped By: Wind River Environmental,LLC Permit 4#:
Contents Transferred to:
contents Disposed at: � Q
SIb% M&
Date: Pumper Signoture:�f�
Condition of System/Other Comments
® w!�!ean�recycieapy:er Dep Approved Form-12/07/95
CITY OP SALEM,MASSACHUSC;'CI'S
BOARD OI,HEAI.11-I
120 WASHINGTON S7REGE,4T FLOOR
Tr:L.(978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR LRAMDIN([!)SALE:NLCOM
LARRY RAMO N,RS/REHS,CHO,CP-FS
HEALTH AGENT
Fee: $50.00
Application for Abandonment of Subsurface
Disposal System
I, 11 c:i fI ky L/i2._a)ji hlu herewith apply for a permit to abandon the
Sub-surface sewage disposal system located at // GARC > 5 i At/F'
Name of Licensed Drain layer: k-F 8 &cAvAri C,
Phone Number: �7 6 .2-615 2 6�Y 7
If tank needs emptying, name of Septage hauler: &AIYPr, r &P%/C
(Septage hauler must be licensed by the Salem Board of Health, copy of the Pumping record has to be provided
at time of abandonment)
Date: //- 21 —//
Signed:
(owner/applicant)
FOR OFFICIAL USE ONLY I Ila I 'qI�I
Amount received ('� C��� 7 b BY: -
Date Abandoned: Witnessed By :
Customer Since
Customer Service Report
E N V I R O N M E N T A L
System Owner System Location
J
CCLS Approx.Gal.
Custom Clean Customer Home
Number in Household 1 2 3 4 5 6 7 8
-
Zabel.Filter System Type - Tank Size 1000 22 20 18 16 14 12 12 12
T5 - Frequency 1250 22 20 18 18 _ 16 14 12 12
Previous Service 1500 - 24• 22 20 20, 18 16 14 14
Service Date Build Up 2000 . 26 24 22 24 20 18 16 16.
/j Depth Below Grade
Se"ices /��'E'U� - Score From Table
Description Quantity Unit Price Ext Price Subtract 6 for Garbage Disposal
/7 Subtract 5 if System is Older than 10 Years
Add 8 for seasonal use
Add 5 if System Additive is Used
Net Score:
Score Frequency'
Less than 5 Every 6.Morths
Subtotal (z-'. 6 to 15 Every Year
Tax - - y-�f'- .16 to 23 Every 18 Months
Total t G Greater than 24 Every 2 Years
. Tank Observations: Potential Solutions: M Details
❑System Operating Fine Wesuggest these 4 keys to keep your system healthy: Payment T e ;--T"�• �— -
1)Regular Servicing
- °1'm YP
2)Bacteria"Boost"at time of service Credit:Cdrd
3)Use Wind River Bacteria Additive - Card
4 Use a filter
❑Excessive Solids Utilize Wind River Bacteria Additive - Security Code
❑Heavy Sludge Introduce additional bacteria via Wind River Boost Program
Ex Date-
Utilize Wind River Bacteria Additive p.
Nee
Missin /Broken Re irTE lace Tee - - -
❑High Liquid Level Could be an indication of system in hydraulic failure. - Terms:
Suggest a system evaluation and/or a.custom cleaning.
Call the o fice as soon as ossible at-978-841-5017.
Cl Distribution Box Issue We observed the fallowing Issues:':
❑Missin Filter Use ofa filter is oneof the 4 ke s to keepingyo6r.systernhealfity
❑Other
The observations and solutions identified may require additional treatment.Please call
our Customer Solutions Specialist at 978-841-5017 for additional information,or call .
our Customer Service line at 800-499-1682 with any questions.
�i ='rv, E t� �S�E.6s Cr �P. , fir —J' {`. ��
Tech Notes: L � v r1
J ✓fir a�� - r �✓ f4".4''
U
�PM
i
dime Arrive Time Left Tech Initials .. - tom gn re 0-001
'r^TIIy1 PonreAonrecvdedvacer �
Rev 2/09
4< 1 h L/k' Customer Copy .
CITY OF SALEM, MASSACHUSETTS
'! a BOARD OF HEALTH
'$q 120 WASHINGTON STREET,4"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRAMDIN@SALEM.COM
LARRY RAMDIN,RS/RF.HS,CHO,CP-FS
HEALTH AGENT
November 21, 2011
Mr. David Dellaire
42 Margin Street,
Peabody, MA 01960
Dear Mr. Dellaire,
RE: Septic abandonment 11 Cedarcrest Avenue, Salem, MA 01970
The subsurface sewage system at 1 I Cedarcrest Avenue, Salem MA 01970 has been properly abandoned on
November 21, 2011, in compliance with 310CMR 15.354, by a licensed Drain Layer. The work has been inspected
and has been found to be in compliance with 310CMR15.
Lary A. Ramdin MA, REHS, CP-FS, CHO, LSE
Health Services Administrator