2 PETER ROAD � Persil /I�A.I (seo�rc)
e
goo do0 ° 00 �
Please call with questions/concems
We appreciate your business
°U��O� �1�QVlJ�l5U
Septic System Fungi on Checkand Pumping Deport
Property hOwner s Name:Property Address: 3 D
Date of Pump/Function Checkb 102011)
Routine: Emergency: El -Technician
r
SEPTIC TANK SYSTEMSingle Compartment 13Double Compartment
*YES indicates there is a robl m, NO indicates there is no problem
YES NO
Tank structure
Breakout or ponding
Liquid level above inlet invert
Liquid level above outlet invert
Tee or Baffles missing or broken @ inlet
Tee or Baffles missing or broken @ outlet
FILTER PRESENT ❑ Yes No TYPE: o
Condition: �� n
❑Cleaned ❑Replaced ❑Installed II`If'
AUG 14 2006
TANK LEVELS AND MEASUREMENTS
Size of tank CITY OF SALEM
Actual amount pumped BOARD OF HEALTH I
Scum layer (acceptable range 1-2")
Sludge depth (acceptable range 5-10')
Liquid level
OVERFLOW TANK PRESENT ❑Yes No
Size of tank
Actual amount pumped
Liquid level
Condition
COMMENTS:
4
coma aweakk of A2saduldss
S -w► . massschusstts
OC��O g 2009
em Pt�m
ACi %V=LYom
OCat101t
Date of Pumpiw E("lv 7 Q=it pumped:1, OVU gallons
Cespool: No yes .❑ sq&Ta* leo ❑ Yes
R&M SEPTIC SERVICE= INC.
Syg= �- d b a B S CO1�AtI SEP IC
COAMM traodbnW to: WAv'L ►i0/1� SU®gUgtY
Date
Was SEPTIC SERVICE= I1
4.s��►t>M►�sic�.i�ooien
commonweahh of 1lunwhttsetts
SALEM , Massachusetts
SySt m ft fjV&9 ¢cord
System rstem ocatton
weer
ROBERT BOUCHARD SENIOR 2 PETER ROAD
Date of Pumping: 1.,0/•20/a6 Quantity Pumped: 1000 gallons
Cesspool: No Yes . ❑ Septic Tank: No ❑ Yes
RAGGS SEPTIC SERVICE. INC.
' Spstem Pumped b:
d .b.a. E. A. COMEAU SEPTIC License n:
Contents transferred to: FITCHBURG
Inspector RAGGS SEPTIC SERVICE, INC.
Date
RECFIVED
NOV 2 0 2006
CITY OF:SALEM
BOARR CF HEALTH
FORM 4-SYSTEM PUNIPL\G.RECORD
Commonwealth of Niassachusetts NOY 19.1000
SALEM , Massachusetts CITY OF SALEM
BOARD OF HEALTH
system Pumping Record
System % Mer bystem Location
ROBERT BOUCHARD JR. 2 PETER ROAD
Date of Pumping: 10-/-G7/05 Quantity Pumped: 1_000 gallons
Cesspool: No ® Yes . ❑ Septic Tank: No ❑ Yes
RAGGS SEPTIC SERVICE, INC.
System Pumped by. d -b.a. E. A. COMEAU SEPTIC License :
Contents transferred to: FITCHBURG
Date Inspector RAGGS SEPTIC SERVICE, INC .
F
FORM 4•SYSM%j PLA jp0•G RECORD
Mgt
Commonirealth of Massachusetts
SALEM , Massachusetts DEC 312003
CITY (DF SALEM
BOARD OF HEALTH
System Pumping Record
yslem ��rter
.•stem Locauon
BOUCHARD 2 PETER ROAD
Date of Pum to 8/19/03 Estimated 1000
p 8 Quantity Pumped: gallons
Cesspool: No ❑ Yes ❑ x
Septic r c Tank: 1\• ❑ Yes ❑
RAGGS SEPTIC SERVICE, INC .
System Pumped by- d .b.a. E. A. COMEAU SEPTIC License r:
Contents transferred to: WAYLAND SUDBURY TREATMENT PLANT
Date 12/16/03 Inspector RAGGS SEPTIC SERVICE INC.
_ g 2005
11111110111
11,11 1111,111
SPLE
H e
CIT`( 0�1��K
.BOARD;. ca with questions/concerns
(afd ofl�, �(r� (afdfo�l11f1(r�(d(a� We appreciate your business
V' CaJLSWV II `V'L5U
PO BOX 7 Wenham,MA 01984
Septic System Function Checkand ftmping If port
Property Owner's Name: rr,, y I �/;1.4;
Property Address: / Pe f e v 09d , Sa4,e "
Date of Pump/Function Check: y //5 &5
Routine: ❑ Emergency: ❑ Technician Qac �,1.� PY i'P Lx v
/je w iv� 5HII
SEPTIC TANK SYSTEM ❑ Single Compartment ❑ Double Compartment
*YES indicates there is a problem, NO indicates there is no problem
YES NO
Tank structure
Breakout or ponding
Liquid level above inlet invert
Liquid level above outlet invert
Tee or Baffles missing or broken @ inlet
Tee or Baffles missing or broken @ outlet
FILTER PRESENT ❑ Yes �No TYPE:
Condition:
❑Cleaned ❑Replaced ❑Installed
TANK LEVELS AND MEASUREMENTS
Size of tank d pG
Actual amount pumped
Scum layer (acceptable range 1-2") A01�
Sludge depth (acceptable range 5-10') it
Liquid level 60 p Cl
OVERFLOW TANK PRESENT ❑Yes PNo
Size of tank
Actual amount pumped
Liquid level
Condition
COMMENTS:
m