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7 CEDARCREST ROAD SYSTEM PUMPING RECORD 10-12-20 Commonwealth of Massachusetts RECEIVED City/Town of Salem System Pumping Record DEC 012020 y Form 4 y DEP has provided this form for use by local Boards of Health.Other forms may be used,but the informaOffrYu@PESALEM substantially the same as that provided here. Before using this form,check with your local Board of Ha0AR&EYFni _1�?,`kl, they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 1� days from the pumping date in accordance with 310 CRAR,15.351. A. Facility Information 1. System Location: 7 Cedarcrest Road Address Salem MA 01970 City/Town State Zip Code 2. System Owner: Tony Losolfo _ Name 7 Cedar Crest Road Address(if different from location) Salem MA 01970 City/Town State Zip Code 9787451320 Telephone Number B. Pumping Record 10/12/2020 1000.0000 1. Date of Pumping Date - 2. Quantity Pumped: Gallons 3. Component: ❑ cesspool(s) Septic Tank ❑Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? 0 Yes© No If yes, was it cleaned? ❑Yes ❑ No 5. Observed condition of component pumped: System Operatipg Fipe Normal water level Heavy top solids Heavy bottom sludge tank is notdesigned- to be used witfi-a Tilfer. Cover s) secure. . Owner had me dig down over 2 ft to outlet side of tank. There is a riser on the inlet. Had to dig 6 ft. Square. Owner would not let me park in driveway. Had to pump from st. Should be a truck time charge added to Bill. Per office only charge extra 100. For *i---4n Ao n.ym , -ri T:t—+ eraAi+i arc rrT.0 �Arii+ilic 6. System Pumped By: Michael Graham Name Vehicle License Number Wind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 01749 Company 7. Location where contents were disposed: 163 Western Ave, Gloucester, MA 01930 10/12/2020 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1