13 HAYES ROAD /3 y.�yes %��
(Ss�ic)
Commonwealth of Massachusetts
Salem, Massachusetts
System Pumainp- Record
System Owner& address:
Leonette Strout
13 Hayes Road 7/�; ��.
41)
Salem, MA
Location of system: Rear yard 1
Date of Pumping: October 24, 2008
Type of system: Septic tank
Gallons Pumped: 1000 gallons
System pumped by:
Service Pumping & Drain Co., Inc.
5 Hallberg Park
North Reading, MA 01864
License#: BHP 2008-0372, BHP 2008-0372
Contents transferred to: Fitchburg Treatment Plant
Date: October 24, 2008 Pumping Technician: CC
This is PROPRIETARY and CONFIDENTIAL information that may be used only
by the Board of Health for regulatory purposes
CURRIERFORM 4-SYSTEM PUMPING RECORD
SEPTIC & DRAI ERVICE
107 FOREST STREET;MIDDLETON,MA 01949 }}�
(978) 774-2772 (S�
OCT4 - M9
CITY OF SALEM
COMMONWEALTH OF MASSACHUSETTS HEALTH DEPT.
MASSACHUSETTS
SYSTEMPUMPING RECORD
SYSTEM OWNER: SYSTEM LOVT ON:
13 ""A k S
DATE OF PUMPING: QUANTITY PUMPED: S
GALLONS
CESSPOOL: NO `� YES SEPTIC TANK: NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO:
DATE: /
INSPECTOR: &tOLA
_ _
o
- -- -
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aAb I'_'�7f/B�5' �C°�
FORM 4 - SYSTEMW O
Commonwealth of Massachusetts DEC 3 -?_f3t33
Massachusetts CI i r 6ALEM
System Pumping Record BOARD OF HEALTH
ystem weer System iocation
Type: Emergency [� _ Routine
Cesspool: No ❑ Y s Septic Tank: No ❑ Yes ❑
Date of Pumping: _ �/ �? l Quantity Pumped: _ gallons
System Pumped by (Company): (y Permit 9:
Contents transferred to:
Contents disposed at:
Date . Pumper Signature
Condition of system other comments:
DEP APPROVED FORM. 12/07/95
Ic- WPV& Q,12iy �� d ���
rORTANT MESSAGE
t `���I� ��
U� TIMEM �.�-ab n
i
OF / r P.
PHONE G1�° '2626-1 L�;>l ,L
AREA CODE NUMBER EXTENSION
FAX
DMOBILE 9�� `�l �So
AREA CODE NUMBER TIME TO CALL
"TELEPHONED - PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH.
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE 211`� 1 1J 0 i--
SIGNED
-FORM 400A. -- -
MAGE IN U.S.A.
NOTES - -�-- _- - - - --
CITY OF SALEM, MASSACHUSETTS
a BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR IMANCINI@SAI IiM CON
JANET MANCINI
ACTING HEALTI-I AGENT
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