SEPTIC ABANDONMENT 2017 CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
'-' 120 WASHINGTON STREET,4'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRAMDIN([�7�,SALEM.COM
LARRY RAMDIN,RS/REHS,CHO,CP-FS
HEALTH AGENT
October 6, 2017
Roger Gagne
34 Cedar Crest Avenue
Salem MA 01970
Dear Mr. Gagne,
RE: Septic abandonment 34 Cedarcrest Avenue, Salem, MA 01970
The subsurface sewage system at 34 Cedar Crest 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.
0,
Larry A. Ramdin MA, REHS, CP-FS, CHO, LSE
Health Services Administrator
SU.AKU UI I14.11:11I
�� 120 W V�iiim;-i l�\, SI11_P:1',4 Fi,o ),
1 ,I..(178) 41-'1800
R�n�Hr-x�ry uRisco�� F\a(9-8)'45-0343
MAYOR 1 R.AAIDIN'nS.U.1 CM.COM
L ARRY RAMDIN,RS/REHS,CHO,CP-FS
HEALTH AGENA
Fee: $50.00
Application for Abandonment of Subsurface
''^ 11 � ll II Disposal System
I, So" LYYf1&Lt ' Y1Gl herewith apply for a permit to abandon the
Sub-surface sewage disposal system located at .3 1 C_Q C ktI' CV-C+- (,I t c'
Name of Licensed/yDrain layer:_riro a)KbsnCfj/tq
Phone Number: %?g 7y1 �VCV c /�
If tank needs emptying, name of Septage hauler: . '(V I C1t CO
(Septage hauler must be licensed by the Salem Board of Health,copy of the Pumping record has to be provided
at time of abandonment)
Date:
Signed•
(owner/ cant)
FOR OFFICIAL USE ONLY
Amount received JYD. n BY: / t 5
Date Abandoned: Witnessed By :
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