18 INTERVALE ROAD CS�n��
Farm 4 -- System Pumping Record _
Commasrealth of Massachusefss
Massachusetts
System Panaln0 Record
System Owner System Ideation
Joseph Darisse Joseph
18 Intelvale Road 18 Intelvale Road
t
Salem. MA 01970 Salem MA 01970 w4
(978) 744-7722 ` (978) 744-77.2
.Tneenh Joseph
Type: Emeryeney Routine
Cesspool: Ido Yes Septic tank: hla Yes O
Date of Pumping: Quantity Pumped: )ions
System Pumped By: Wind RArcr Eaviroamsatol, LCC Permit 7F:
Contents transferred to:
Contents Disposed at: .
sj)
i
Date: Pumper Signature:
Condition of System/Other Comments
gGSAWD
Dep Approved from - 12/07/95 JUN 2001 5
HEA�H DEPT .