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411 System Pumping Record 2012 stem Pumping Report Greg's Wastewater Removal 239 A Greenfield Road South Deerfield,MA 01373 Phone 413-665-3989 Fax 413-665-7358 * This report will be sent to the BOARD OF HEALTH within 15 DAYS ****** .rmit# AtIP-9015'6723 MA License# Date of Pumping 7 /2 el/ /S Address operty Owner GEORGE MARTIN Address 2 ime Phone 413-585-0195 Address 3 is Phone City II Phone 413-364-2756 State nk Size: 1500 GAL Concrete Good FLORENCE MA Zip Code 01062 Total Volume: 1$00 (xr.., ank Location SKETCH ON FILE Septic %( Holding Tank Leach Tank Cesspool Grease Trap to of Previous Pumping, If Known: 3 2- 12 iste Received at Licensed Facility: Mnr -Twat e_ ensed Facility Phone Number: 11 3 - SgGO S Nn: + fc Comments: fiver: 7 a fated 7/24/2015 at 9:38:09 AM Page 1 of 1