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12 HAYES ROAD
/ o? /�AycS iCo•sa( C`�'~'`� � J RECEIVED 07/27/2016 11:40AM 9787450343 Salem Health Dept 07/27/2016 11:35 9782814869 WINDRIVER PAGE 05/06 A'N17n7dnd4 05MI/2000 Commonwealth of Massachusetts Form 4--System Pumping Record SZD% Massachusetts System Pumping Record System dwner --- System Location Labcecque Carmen Primary Some 12 Hayes Road 12 Hayes Road Salem, M, 01970 Salem, MFS, 01970 (978)-749-7336 x (978)-744-7336 x Labrecque Carmen Type: Emergen Routine Cesspool: No Yes Septic Tank: No YesO Date of Pumping: uanti J, Q tY Pumped: /Or>U Gallons System Pumped By: Wind River Environmental,LLC Permit#: Co"ento Transferred to: Contents Disposed at: cr �� Gate: Pumper Signature: Condition of System/Other Comments Jfl'\ Ue /.Sem a+melwmrygww,pc� Dep Approved Form-12/07/95 02/12/2016 15:06 9782814869 WINDRIVER PAGE 06/14 ,. nw.iu�...ann nn n.^.mS Mf11S(1 Commonwealth of Massachusetts Form 4--System Pumping Record i6% Massachusetts System Pumping Record System Owner System Location Labreoque Carmen Primacy Some 12 Hayes Road 12 Hayes Road Salem, MA, 01970 Salem, MA, 01970 (978)-744-7336 x (978)-744--7336 x Labrecque Carmen Type: Emergent Routine Cesspool: No Yes Septic Tank; No Yes Date of Pumping: L— �E— II-- Quantity Pumped: 1�_v _ Gallons System Pumped By: Wind River Environmental,LLC Permit#: l Contents Transferred to: I.W.W.T-,P�A Contents Disposed at: I Ams. Date: Pumper Signature: Condition of System/Other Comments ® I,,;�wno�rc,y�mawxDep Approved Form-12/07/95 0211212013 13: 29 9782814869 WINDRIVER PAGE 01/03' Commonwealth of Massachusetts Form 4--System Pumping Record r Massachusetts system Pumping Record System Owner 712 Location Zabrecque Carmen rimary Rome 12 $ayes Pd Eayes Rd Salr:a, MF., 01970 Salem, MP., 01970 (978)-744-73.36 x (976)-744-7335 x Labrecgtle Carmen Type: EmergencERoutine Cesspool: No yes Septic Tank: No Yes Date of Pumping /c//'7//4--- Quantity Pumped: Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: \A(. . �'� 3 o Zone OIIV -roun-Ion MA Date: /0�/7�/Z.- Pumper Signature, �' ^ i Condition of 5ystem/Other Comments �nvaor'MEvrn. t��co�S Drain Problems? We're Local&Fast 1-866-866-6214 ® Yrimmcr.rencr-apaprr Dep Approved Form-12/07/95 r Commonwealth of Massachusetts Form 4--System Pumping Record b• a!'d'+ Massachusetts System Pumping Record System Owner system Location t(ly i kat ({'0.r [r -1'1,(0 y.i .�� d� a• n19t , .y... Type: Emergent Routine Cesspool' No yes Septic Tank: No Yes Date of PumpingJ Quantity pumped!6L�6J,� Gallons System Pumped 8y: Wind River Environmental,LLC _ Permit M Contents Transferred to; Contents Disposed at: ..m.�..—....._. Dnte'. _,_ Pumper Signature: Condition of System/Other Comments nkdonrearclen;a! r Dep Approved Form-12/07/95 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Labrecque Carmen Primary Home 12 Hayes Rd 12 Hayes Rd Salem, MA, 01970 Salem, MA, 01970 (978)-744-7336 x (978)-744-7336 x Labrecque Type: Emergency Routine Cesspool: No Yes Septic Tank: No Yes Date of Pumping: 0 Quantity Pumped: 1000 Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: �i-,]VED Contents Disposed at: SEP 13 2010 S.E.S.D�.. Salem A '. Date: Pumper Signature: Condition of System/Other Comments ® Printed on recycledpn,er Dep Approved Form-12/07/95 0222028574 '� , 05/09/2000 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Labrecque Carmen Primary Home 12 Hayes Rd 12 Hayes Rd Salem, MA, 01970 Salem, MA, 01970 (9781-744-7336 x (978)-744-7336 y. Labrecque Carmen Type: Emergent Routine Cesspool: No Yes Septic Tank: No YesE;�— Date of Pumping: to-ra Quantity Pumped: / Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: r V Date: Pumper Signature: Condition of System/Other Comments IRES D MA. ( ® w,ntedon«ydenroa, Dep Approved Form-12/07/95 r .-CEIVED NOV 0 6 2009 i k rnnnnnorv3o n;lntrannn Commonwealth of Massachusetts Farm 4--System Pumping Record Massachusetts System Pumping Record A System Owner - System Location L•abxecqui� l.utlaen Primary Home 12 Hdy.;� kd 12 Hayew ed Salvor, MA, 11197u Salhm, NIA, 01470 (5�H1- i44J'Iji6 x (979) -744-1,130 x ` Labrecqun Carmen Type: Emergent Routine / Cesspool: NoI Yes Septic Tank: No Yesl Date of Pum in p 9.,�DIn0 Quantity Pumped: lioob 'Gallons System Pumped By: Wind River Environmental,LLC Permit#: E. Contents Transferred to: , Contents Disposed at: Ipswich Water ' Plant Ipswich, MA O103,q Date: Pumper Signature: hip ` Condition of System/Other Comments '�i;;;nSl •.rV< + � a Dep Approved Form-12/07/95 c }_ DEC - 82006 Commonwealth of Massachusetts Form a--System Pumping Record Massachusetts System Pumping Record System Ovmer- JK System Location 1W ` Laorecque Carmen Primary Home It Mayes Ra It Hayes ka Shcem, MA, 01910 Salem, MA, 019'/U t9/t ) -'745-7i3n x i0N)-/44-1-Qb x Lanrecque Carmen Type: Emergen Routine Cesspool: No Yes Septic Tank: No Yes Date of Pumping: /0 Quantity Pumped: /90z) Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: Date: Pumper Signature: ^ Condition of System/Other Comments FRIECEiVED DEC 10 2007 CITY OF SALEM BOARD OF HEALTH Dep Approved Form-12/07/95 Form 4 -- System Pumping Record Commomweahh of Massachusetss Massachusetts System Pumping Rewrd System.Owner -..._ System Location Lanrecque Carmen Primary Howe 12 Hayes Rd 12 Hayes Rd Salem, MA, 01970 Salem, MA, 01970 (978)-744 -733b x (978)-'741--7336 x T.-.`h Type: Emergency Routine Cesspool: No I Yes Septic tank: No =Yes Date of Pumping: /Or Zy/0�/ Quantity Pumped' 50 U Sali mz System Pumped By: Wind Nl Environmental, LLC permit#: Contents transferred to: Contents Disposed at: S� Date: pumper Signature: V Condition of System/0ther Comments CITY 0- JALLM BOARD OF HEALTH Dep Approved Form - 12/07/95 Form 4 -- System Pumping Record Commanwsalth of Messachusetss Massachusetts System Pwrroinu Record System Owner System Location ..ala'e Ct{af.+ Ua Mon F'5:1:435'! F1,7TE B:nyom F•d on l.�e Ao 01970 's'elea MA, 01M) �'I 13A •73.36078 I-" i. 3, 14v'"-•7336 Type: Emergency Routine cesspool: Kb Yes Septic tank: w =Yes Date of vamping: /��/ (i Quantity Pumped: ,�,5 Q Gallons system Pumped BY: wJnd Rima•awonmenro7C ue Permit#: Contents transferred to: Contents Disposed at: 'S 'C_J Date: �� a Pumper Signature: G� V Condition of Systun/other comments Dep Approved Form - 12/07/95 Form 4 System Pumping Record ISI Commonwealth of Massachusetss I Massachusetts System Pumpim Record System,Ci'mar System Lacotwn Rd IV, Lf m, MA, I Type; Emergency Routine E:l [D� Cesspool; No Yes Septic tank: KID Yes Date of Pumping: > Quantity Pumped: i 6allons System Pumped By: Wind P~ammoental, LLC permit#: Contents transferred to: Contents Disposed at: Date: Pu mw skjnature: Condition of System/Othw Comments TEP JAN 12 2004 CITY OF SALEM BOARD OF HEALTH Dep Approved Form 12/07/95 ' Farm 4 -- System Pumping Record Comnianveath of Massachusetss Massachusetts System Pumoina Record System Owner System Location .r,rr,r qu« 17 amen Pri.msiry Home �._ wry...; Rd 14 Hayaa Rd .,.,�. MA. 31370 „a l..m. NA, O1B70 ' iii•! -744 -7336 X Ii7Hi) - '91-76e,4 X Type: Emergency - Routine Cesspool: No Yes Septic tarn: No =Yes ©� Date of Pumping: I r- 75 6 �^ Quantify Pumped: S CTO 6allons System Pumped By: Nind Rive Envannmento% LCC Permit 71: Contents transferred to: Contents Disposed at: ,A Date: Pumper Signature: Condition of System/Other Comments Dep Approved Form - 12/07/95 Form 4 -- System Pumping Rgcmd Commonwealth of Maswthusetsz Massachusetts System Pumoim Record System Owner _ System Location CAW7N LABRFOVJE Carmon I HAYES P.0 12 Hayes Road SALEM. MA 01970 4324 Salem, MA 01970 (761) 293-7664 (978( 744-7336 744.6977-7336 Type: Em-g-wyl I Routine Cesspool: No Yes Septic tock: NO Yes Date of Pumping: l Quantity Pumped: Ibns System Pumped By: Wind RiN Environmental, LLC Permit ii: Conmans transferred to: Contents Disposed at: Date: pamper Signature: Condition of System/Other Comments Dep Approved from - 12107195 i 2 Cill,l S C7� j s -------------- j6t Ic Qu f- I�l�4Ay es RD 3ci Ue m tA -A ------------ 1 7 ti C o •yCS ID Z�L )jjc D r-7 DaLe �)f )Pulll C s p [1 91-,2-S-_=(00 aallons 3 ) A.S. STRONG S#ptkC System Sarvim I" 163 Wevern Avo— --- G4QwQwsta(, MA 01930 Dace Corldi60R of R 8, STRONG Septic sy4tcm sg�im Lj,�C I .- 163 vv� .traern Ave. K. V4 to C#4 f A L 'QIQU"sWf, MA 01930 7 107 Forest St. �N FORM 4- SYSTEM PUMPING RECORD Middleton,MA 01949 �pP (508) 774-2772 vr, G� 5EQ 9(cAv� co onwealth of Massachusetts OEM , Massachusetts NOV 1 3 1996 w f �LT F DEPT' . System Pumping Recard Ystem caner ystem ocauon 2 / Ac, u-Q. Date of Pumping: C Quantity Pumped:4LL)4allons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by: /_ — Contents transferred to: License #: .. Date Inspector • THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY •