The URL can be used to link to this page

23 CEDARCREST AVENUE - SEPTIC RECEIVED 06/16/2017 04:59PM 9787450343 Salem Health Dept 06/16/2017 16:52 9782814869 WINDRIVER PAGE 01/05 Commonwealtt of Massachusetts City/Town of , h-. System Pumping.Record Form 4 DEP has provided this form for use by local Boards of Health.Other forms may be used, but the Information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important When . filling out forms 1. rEystem Location: an the computer, use only the tab LLL key to move your Address cursor-do not S6 ` MA use the return key. Citymown State Zip Lode 2. S1m Own : ` r �-� Name lana Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Ooeta u 2. Quantity Pumped: lall©o 3. Component ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap [] Other(describe): 4. Effluent Tee Filter present? Yes ❑ No If yes,was it cleaned? (Yes ❑ No 5. Observed condition of component pumped: 6. System Punpcdd By: TZ r Name Vehicle License Nu%%d River.$I1V1r071II1CII Wind River Environmental 163 Vl76StCrq Ave, Company Gj,Du=t4:;MA 01930 7. Location where contents were disposed: Signature of Hauler Date I W�yW��..,cP.� Signature of Receiving Facility(or attach facility receipt) t5fomn4.doc•11/12 System Pumping Record•Page 1 of 1 RECEIVED 07/27/2016 11:40AM 9787450343 Salem Health Dept 07/27/2016 11:35 9782814869 WINDRIVER PAGE 04/06 Fl9C14h%h90A 1 n17b12010 Commonwealth of Massachusetts Farm 4--System Pumping Record 620t Massachusetts System Pumping Record System Owner System Location Maitland Peter Primary &ome 23 iedarcrest Avenue 23 Cedarcrest Avenue Salem; MAS 01970 Salem, MA, 01970 (978)-745-3913 x (978)-745-3913 x Maitland Peter Type: Emergen Routine Cesspool: No yes Septic Tank: Na Yes Date of Pumping: — r / Quantity Pumped: Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: Date: Pumper Signature; Condition of System other Comments ffi a .�ieipoper Dep Approved Form-12/07/95 09/05/2012 11:27 9782814869 WINDRIVER PAGE 02/03 N d20703328e i0Y?St�090 Commonwealth 0f MasaachusettS Form 4--System Pumping Record MassochusetU System Pumping Record System Owner System Location Maitland Peter Primarl home 23 Cedarcrest Ave 23 Cedareca3t Ave Salem, Kit, 01970 Salem, P%, 01970 (978)-745-3913 x (978)-745-3913 x Maitland peter Uwe:_ Emergen Routine Cesspool: No Yes Septic Tank No Yes Date of Pumping;- -7-1 R-IZ Quantity Pumped: lr= Gallons System Pumped 8y: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: S EAD. ICM -MA bate: Pumper Signature: Condition of system/Other Comments ® Rima�anrccy=i=aPo�� - bep Approved Form-12/07/95 05/08/2013 13:32 9782814869 WINDRIVER PAGE 05/07 6-1107i12A7612 VY7.512010 Commonwealth of Massachusetts Form 4--System Pumping RecordM'rO Massachusetts System Pumping Record System Owner System Location Nie].t'+.3Ad .:e't:e - r iati,ry Homs- 23 Cedarcrest Ive a' CedaLrcrest Ave a'em, MA, 01970 S lam, Mh, 01.970 (576).-715;913 x ;978) -796-3913 Y HtAiLland Peter —E Type: Eme76- Routine Cesspool: No Yes Septic Tank: No � Yes Date of Pumping: 7. 1:3 Quantity Pumped: Gallons system Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: j0wxb,MA. Date: L' Pumper Signature: Condition of System/other Comments 5cc,ub Dep Approved Form-12/07/95 05/08/2013 13:32 9782814869 WINDRIVER PAGE 04/07 naaym:i,a°�ra 9 nfgv17n s n Commonwealth of Massachusetts Form 4--System Pumping Record266% Massachusetts System Pumping Record Sysfem ovine — - System Location N'd,rt7and Fl.o_e r_ Intim xy Home? 23 iedal; rest ?rve 23 ceearcreat Ace Salem, MA, 01970 Salon, Mk, 01970 {97$)-78�-3'913 x ;57&) -745-3913 x I2ai27z,nd Peter Type: Emergen Routine Cesspool: No yes Septic Tank: No yes Date of Pumping: 3 / - /3 Quantity Pumped:�J Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: - Contents Disposed at: im.W i P M tviclf� A_ Date: Pumper Signature: Condition of System/other Comments 7 . ® Prin�donrtyckdp + Dep Approved Form-12/07/95 5/07/2012 15:54 9782814869 WINDRIVER PAGE 02!03 P47030933 10125/2010 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Maitland Peter Primary Rome 23 Cedarcreot Ave 23 Cedararest Ave Salem, MA, 01970 Salem, MA, 01970 (978)-745-3913 x (978)-745-3913 x Maitland Peter Type: Emergen Routine Cesspool: No""// Yes Septic Tank: No Yes Date of Pumping: CLQ. Io IL- Quantity Pumped: �Jb Gallons , System Pumped By: ll Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: 5.B.S.D. Salem YMA. bate: Pumper Signature: Condition of System/other Comments r / rrmudonrt�yddpo�. Dep Approved Form-32/07/95 P15/07/2012 15:54 9782814869 WINDRIVER PAGE 03/03 vRJ2O7O 932 CW0512®12 commonwealth of Massachusetts Form 4--system Pumping Record L260% Massachusetts System Pumping Record System Owner System Location Provencher Claire Primary Home 32 Cedarcreat Ave 32 Cedarcreat Ave Salem, MA, 01970 Salem, MA, 01970 (976)-744-5531 x (978) -744-5531 x krovencher Claire Type: Emerges Routine Cesspool: No Yes Septic Tonk; No Yes Date of Pumping: .11-11t) Quantity Pumped: 4�U Gallons System Pumped By: , 1 Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: �� S.E�.S. . r7AW&MA Date: Pumper Signature: Condition of System/Other Comments �i �i� rE4Y ® �� im Dep Approved Form-12/07/95 OF,/07/2012 15:54 9762814869 WINDRIVER PAGE 01/03 Wind River Environmental 577 Main Street, Suite 110 Hudson, MA 01749 May 7, 2012 Please find attached our disposal slips for the month of April. If you have any questions or concerns please contact me. Best regards, Jamie Coble Office Administrator 978-282-7315 163 Western Ave, Gloucester, Massachusetts 01930 ph 978-282-7315 fax 978-281-4869 e-mail jcoble@wrenvironmental.com 0222033166 10/25/2010 Commonwealth of Massachusetts Form 4--System Pumping Record 4% Massachusetts. System Pumping Record System Owner System Location Maitland Peter Primary Home 23 Cedarereat Ave 23 Cedarorent Ave Salem, MA, 01970 Salem, MA, 01970 (976)-795-3913 x (978)-745-3913 x Maitland Peter Type: Emergent Routine Cesspool: No Yes Septic Tank: No Yes Date of Pumping: `Q i- ) Quantity Pumped: lavO Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: S.E.S.D. Salem, MA. Date: Pumper Signature: `/^�`/�'�"�'"�'� Condition of System/Other Comments ® Prinmd.nrec,W,.pe, Dep Approved Form- 12/07/95 I I I I I ='ECEiV'L vuf+ to ✓r IiEALlli I FORM 4 - SYSTEM PUMPING RECORD D � Commonwealth of Massachusetts JUN 3 - 1999 Salem, Massachusetts CITY OF SALEM HEALTH DEPT. System Pumping Record System Owner: System Location: Peter Maitland rear yard 23 Cedar Crest Ave. Salem Date of Pumping: May 7, 1999 Quantity Pumped: 1500 gallons Cesspool: No /X/Yes / / Septic Tank: No F-1 Yes /X/ System Pumped by: Service Pumping & Drain Co. , Inc. License # Contents transferred to: Salem Treatment Plant Date: May 7, 1999 Pumper: S.B. This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes. t i FORM 4 - SYSTEM PUMPING RECORD 7UPSAVED 1 MAY 5 - 999 Commonwealth of Massachusetts jTyO SALEM Slem, Massachusetts System Pumping Record System Owner: System Location: Peter Maitland rear yard 23 Cedar Crest Ave . Salem Date of Pumping: April 10, 1999 Quantity Pumped: 1000 gallons Cesspool: No /X/Yes / / Septic Tank: No / / Yes System Pumped by: Service Pumping & Drain Co. , Inc. License # Contents transferred to: Salem Treatment Plant Date: April 10, 1999 Pumper: S.B. This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes . • 3 CONSTQUGTION NOTE 5 Y r •moi -~- ��rt; -A4T. INLMT eL-W T1I.1 FROM 6LW To SED,is IAwYK oe Ag �.rrnvN o.J � ` ~ ":•h PL.LA 1-! (-Mf-&'h t- 1 16 4 ACGi� M4NI-�OL.a J PLAN ) 5WALL f5e 'I-- '-i (_l.) IN OIA. CAST IQOWPIPt - 1 To F,Ni'1V OG(CA�T I�.e..J F mirrm Ticm"7joiNY,- PiTGueD 6 M IN. OP�a 1FCx:JT. �••._K'Iyn� .QRs A Z { FICA Mc f(�YGQ �\ }' 1.2 F¢OM SEPTIC IAWK To DiST bOv. -1Wt LL 6t _ '-.,�-.. s>„ ....� :w.,.;. -. -• --- - -- � 0 A sIrAll, N, 01oAxV-roC L-EAL cNo,NP�V,C 4¢PEr.rar�weDo�LAL LMIN of %g /IFOOT - iC.!uT -30%"T5N -- Z � F- -- . Q �AC.o¢P�/G•. NIN. OF _ 1 {N-5PECTiOwi + 5'-O FQ.OM DI'�T. LAIC> U LBJeL :SEG PQAFILE; - JCOv6/L(G 1.4IW LEACµ ACEACLEAr-%W f5p-P oR I 5W&LL FSe Fou¢(4)1W. DIA. F)ERFOQATBO P..VGJU Nf� / x�,7e o PI Pt - SAID PezFo;,.A:Tlow3 oDViW. n ii rI Lem ALT INLLT ( �Ee PQOFiLEEl DeTAtI� ; -2 �-- _ PLAN VI L-W 2 01nTBIPUi10W � - '> I 2 I 0131- � 7ur L K. NAL bE: OF STD. MFCGR Q wNl�u "DePQeCA� QEi"Fo¢r_ao CouceETa Z V) U D ��L�ti1 tzeex. , Cs1 S'1- IRON FstAME �COYeR FtxL MoiTOR COU' �-¢uc T 101.1 (� pe G.i��' 'lip Moo3. 5Er�-i-i e TALI �. u u, J ..� { I - MANUOLA Fi•TDtJTt0" To Fir4iaAA GOIL& e, tl VVIT ram "�.` •'T- -� --J} _ _ r _ �J. I SEPTIC TAWV- 9�14LL fbe OF STD MFC-,2 . L- a Fvu. Mo4TA7. 60D PQI=CA9'f REINFoacav Co"ce.ETe- {L IT COtJ!5TQUCTl0" SEE DE7AIL9 !. MIu. L.APAGi'C`� OF TANG. i ^Of% �dL1.CT�-+O . -L ` w1s.c uQvio LwwL - ,ftmeL 4. LEAcwA2eA: L K IC ,^If1.Fv 1✓CG : ', 4.1 STQIP OF &L-i- TOPIr 5uE 'OiL+J Ei:�71.1E� I rb",eL '>4.03 ~_ ii -r Vf 9UITAP�LE MnrE¢in pxj,Lp,ti7_rl L1►dIT LIf,e °fo.o �''. i- NOTi` r• 4.2 FILL IN LcAC.J A¢EA TO f5 CLa4f,4 WARP ✓yl ! -SEPTIC TANK 5WDt,LC) S4NOS CaA\.'eL'S - F:Me OF ALL FOaEtc LIJ 'rk\ . r)l.� t I 5C jW*5tPECTE0 ANMVALLY .0 _ 5-� �.. MIAYER,A'�- to PSE APPCOV'EO PRIOR TOPLACEMENT f� ANO PLJMPao ♦R MA1 `t FIL.L :Li.IALL bE .lLLOwaD Tu 5E-ii LE IIJ P"clt- �° D a �_ 44�4.Fx t1'- , gff NEGH�i4R (. I �i < CG ) MONTL{J 02 PSE COMPACTED FSY 14 I '•1 APPROVED MEG.H. META r-19. FILA 'S LiALL L16:�E .,� MAx . PEQC- OF 1 IN 5 MIN. I'J AL�.CE + .Z 4.3 JTOf-iE U-5EO Iu L.E.ACN Q2EA 9LIgLl ME- OF ie _ •9 11 . OF ''ILE15 SNO\v IN DE-7411-5E, 5"AL.L ,D,1{ . a... Pm: ,vA5t-IEn FQee OF ALL FOa EICN I � , 101.5 SCALE ; o SECTION A - A ( 2. MA Ts2 PRIc.� To V acE �., :rs� 4 1 7W&.43,eoC- C) F.T /AIL-- • _SEPTIC TAyK 000 �~ LiQulo CA PA%C ITY 5.1 ALL ' JOVK 9UG:_L f3E To 1-'u[ ' �c9 j �nRAUE9 9NO�Y�! OQ `O 9UGu <.'J'. uE4' I A:'5 MA : ,7E D1REr. `000 PJv THE AND;Jit -uE I5oA2U .'7F 'We1,L-- . +•101.7 5.2 02 ADOI TiON9 TU THE a{�•7 i�� 1 I, OF TLJ,�'j PJUIL01/,1(,, !4 L14L1 P!E MADE ! Y10'L Oj ' 10112 V h ;• - -- - -"- --� 1 1YITMOLUT RQIOQ 4PV4�i•J A;.. OF THE �+ i t - - _ J - IXIgKO OF NEA l-.1-N . I •• _ J iUE LONTR4CT02 "unLL NOTIFY TNF 104.`7 %I , t< `1� � J - 1 PQOPee I..IS PELTpR4 E, 6tL,0VV -SUCLl 111= rOb, A5 REQ UIzEO FUQ hlOPEiCT,OuS. 0 �I Dr- 4 ECTlOW .p. � __ -.� -- - --- view PLAN VIENN -TE5T RE3ULT:3 e4 OEC DATA �- ,els __ - ' I J 41l OETAILg DIgTRIbN 50)(UT50)( SuevcYS�avlcE,luc. , �.�+o� Iii � I ., � � ` n J, EH C-LEc1 IOt•S� a J�� mac " r 4 Tue PQEOENCE OF FOR, ^ to od { TLA yip �l BDAfLf7 OF L1EGlT ' I L. 5011U. It..IFOPl•'1A?ION i�' - i�U FIN{7'1a 'UQFQC TET' PIT TPEWL. MTOTAL nCOf4 G20L1N�7 �VATL'2 f - -_�-- L '.-.. V I . G or S• Trp• �. 1 ° 4 � n _ - ro.l Ffll D_,Q I t r , t v I H •ee \ •.• oe 5cel PTION OF 30i L.s: o Q - `�� A� O 1 • �� _ icr _-- Lr�[;J n_._�. ,�`�Y �:Io 1 �' a - P20G Fn1,S.J SJZF{,Ce _. urn 501 or COR1poc>}i Cl FIII _ TIC _ �F �ITOR1 STc+rE OL�•0 ,__. i V I --� apace TOTAL Le ACiwciAQEA �IMELI�IDNO • r !p'. _ - 1� f�� [y . Q - o ?1p,R,�F,LL�acr•1: TrnG1imv' IO o . LlAcw,N An Ptoa '` O' 5x4R �., W r•. 4 � 9 �'I -----• . � ct (.u -r Feb ,Fe_b , ' OETAI L"S LEACNINg AREA � c .. F;+OW...SO r ,\L . PE2 PER.9pN Pty L•.• T1 I XlaL 1+o1L 11'_ "7�' 3E<TIQN B Mix DAiLJ F ow(Deo;F. ;--.Q" raALlr �-� _ .- vi�T ! ^ 41. 0" HOT 1-•v 5C•AL t [DG; _ . LL. �TAUTOM ATIf��VA�ta -R . �F.'?1 No _ - I , _-- 1`�4 J ! RECn13T'EREL` # NF 9Y NOTE T Le - 'S�ANc=F l fr '• - OF A PERMIT TU C�NO I.2 LJ C. T LC 9(-�[> L A cr - -. - .CATS JF G.Oti1PL1.7.AICE AFTE2 CON9TQLX--nJI C*%ZTIF`( THAT I "AVE JUPEQ'�•'t�ED T..tE coI,1STQUCTION OF THE: 9LtP�.lC-__C_.�- pi'SPOSAL_ rj Oca1Gr+ txLi:.: RATS rn�', V-•4 -- - - �1.{ALL f.:0-1- DE' CC:7N�'"{CUED A°9 A ' FACT LI T1ES GuD TN4T vTT.J 1v+( 1-1 q.J@ 6G-EN COF.i S•1TZUGTEp Gr-Cc>QC)i IG T"O T-NE APPR,:)\,'Eo TL{pT SNE_ �Y5T EM WILL PLAN5 AND A2TICL.E aL OP THE STATE SANITARY CODE �eFri� areM 3Nc»Lo _ oe aeavlce0 aNN�a'_ �_, r��o �, �r-o _ _ .g ? f .� 1 08/02/2012 11:27 9782814869 WINDRIVER PACE 05/05 0207033378 9dL'_ 2dt1@ Commonwealth of Massachusetts Form 4--System Pumping Recordg'ZP Massachusetts System Pumping Record System Owner System Location Mai':lancl Peter Primary flosre 23 Ceiarorent Ave - 23 Cedarcrest Ave Salem, mA, u1970 Salcm, M, 01370 (978)-745-3913 x (978)-745-3913 x Maitland Fet:er Type: Emergent Routine Cesspool: No Yes Septic Tank: No Ye;Z Date of Pumping: Quantity Pumped: Gallons System Pumped By: Wind River Environmental;LLC Permit#: Contents Transferred to: Contents Disposed at: &E.S.D. Q-1 %IA .ice►. Date: Pumper Signatpre: Condition of System/Other Comments 7 ® NnmdonMyCexP= Dep Approved Farm-12/07/95