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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