SEPTIC ABANDONMENT 2017 aCITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL Fax(978) 745-0343
MAYOR LRAMDIN@SALFM.COM
LARRY RAMDIN,RS/REHS,CHO,CP-FS
HEALTH AGENT
October 6, 2017
Attn: Kenneth Provencher poa Claire Provencher
32 Cedar Crest Nominee Trust
PO Box 956
Salem MA 01970
Dear Mr. Provencher,
RE: Septic abandonment 32 Cedarcrest Avenue, Salem, MA 01970
The subsurface sewage system at 32 Cedarcrest Avenue, Salem MA 01970 has been properly abandoned on October
6, 2017 in compliance with 310CMR 15.354, by a licensed Drain Layer Spencer Contracting. The work has been
inspected and has been found to be in compliance with 310CMR15.
n I
Larry A. Ramdin MA, REHS, CP-FS, CHO, LSE
Health Services Administrator
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11 I..(978) 41 1800
F yr(9"8)745-0343
KIMBERLEY DRISCOLL 1 R VAI1)I4(1 ti V7 I:�AL('UTI
MAYOR
I.,\RRl R:AMOIN,Rs/RFiHs,Clio,CP-Fs
HEAI TH AGENT
Fee: $50.00
Application for Abandonment of Subsurface
Disposal System
herewith apply for a permit to abandon the T
Sub-surface sewage disposal system located at 3— 1 .QCLL C0e&1 C-LL4 -
Name of Licensed Drain layer: SS�r�r�t��
Phone Number: Y/ a)on
If tank needs emptying, name of Septage hauler: h Co
(Septage hauler must be licensed by the Salem Board of Health, copy of tl a Pumping record has to be provided
at time of abandonment)
Date:
Signe
�'.wplicant -
FOR OFFICIAL USE ONLY
Amount received 5_0 1 0 h BY: }�l
Date Abandoned: Witnessed By :
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