395 Pumping Report System Pumping Report,aWastewater 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 /DA YS " ""
Permit#\1'I`C)•).,:p MA License# Date of Pumping CC /7C /A ‘
()C.:2.'0\0 Address 395 AUDUBON ROAD
Property Owner LISA BASKIN Address 2 P.O BOX 314
Home Phone (413)586-4127 Address 3
Bus Phone City LEEDS
Cell Phone State MA Zip Code 01053
Total Volume: \ CJ
Tank Size: 1000 GAL
Concrete
Good
Tank Location SOUTH OF HOUSE NEXT TO WHITE FENCE
Septic l4Holding Tank -_J�1 Leach Tank r Cesspool Grease Trap `_
Date of Previous Pumping, If Known: C 1\
Waste Received at Licensed Facility: & -w
Licensed Facility Phone Number:
Town: `Gi' t\C,
Misc Comments:
Driver: �A---/ - - --- _ —
Created 6/27/2018 at 3:24'.47 PM Page 1 of 1