40 CEDARCREST AVENUE - SEPTIC ---------
Commonwealth of Massachusetts Form 4--System Pumping Record 0%
Massachusetts
System Pumping Record
System Owner System Location
Frizzie Kathleen Primary Home
40 Cedarcrent Ave 40 Cedarcrest Ave
Salem, MA, 01970 Salem, MA, 01970
(978)-741-1655 x (978)-741-1655 x
Frizzie Kathleen
Type: Emergent Routine v
Cesspool: No iI Yes Septic Tank: No YesF71
Date of Pumping: I IRI / 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
® Noted on on�yeiedr.ar Dep Approved Form- 12/07/95
A.- A999094469 V10112000
Commonwealth of Massachusetts Farm 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Frizzie Kathleen Primary Homs
4u Cedarcrest Ave 40 Cedarcrest Ave
Saiem, MA, u1970 Salem, MA, 41970
(918)-741-1655 x- {978)-741-1055 x
Frizzie Kathleen
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No Yesd
Date of Pumping: Quantity Pumped`( QCD Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
u
Contents Disposed at: `STH Ipswic 4,� Water
Treatment Plant
Ipswic
Date: Pumper Signature:
i
Condition of System/Other Comments
r�
Dep Approved Form- 12/07/95
�I , 15 R \I 7? 577 Main Street,Suite 110. Hudson, Massachusetts 017491 E-Mail:
ENVIRONMENTAL Telephone 978.562.4500 Facsimile 978.562.7255 wrenvironmenta Lcom
December 6, 2004
Wind River Environmental
163 Western Ave.
Gloucester, MA 01930
Board of Health Administrator,
This package contains the dump slips for the Board of Health from the field office
located in Gloucester, MA. This is the work we have completed.
If you have any questions, please feel free to contact our Director of Field Operations,
Brad Robertson, at 978-282-7315.
Thank you,
Miss Jillian . aFlam
Form 4 -- System Pumping Record
Comnnrseealth of Alassachusetss
AAassaclnsetis
System Pumoina Record
System Owner System location
. r.i"..i? .:i,-.Xi
I r ("-,1<ixr r:rit AV
Ai ,ecaarcrest nv::
a'' -n,., ;:.., 01970 ,�e`° M
, -, irtiir A, "!�. 170
{97H+ . ?A -2e;55 x
Type: Emugenry Routine (/
Cesspool: No Yes Septic tank: Mo Yu
Date of Pumping: I l"C:) Quantity Pumped: ealkms
System Pumped BY Wind Rina EnI wwmeanln/, LLC Permit it:
Contents transfused to:
ColAsnts Disposed at:
Date: pumper s4mature;
Cadition of System/Otlnr Comments
Dep Approved Form - 12/07/95
FORM 4-SYSTEM PUMPING RECORD
RMER
SEPTIC & DRAIN SERVICE yuj���� 1 �
OREST STREET; MIDDLETON, MA 01949 ICS
(978) 774-2772
NO 1 5 1999
CITY
CO WE LTH OF MASSACHUSETTS
Cox,,�/�'G G� MASSACHUSETTS
SYSTEM PUMPING RECORD
SYSTEM OWNER: SYSTEM LOCATION:
/� "�
/ 131UC �cozrllm4e qa/ial�
y
7 C��STP'ecll
DATE OF PUMPING;_ ie ' IIS QUANTITY PUMPED: / S GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO ( YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: S�S�
)ATE: 0 INSPECTO