112 System Pump ReportSystem 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 ******
Permit # D W q ° MA License #
oc)b\ L
Property Owner JON DEVANANDAN & ELENA
MASLOWSKI
Home Phone (413) 575-9758
Bus Phone
Cell Phone
Tank Size: 1000 GAL
Concrete
Good
Tank Location
Date of Pumping ājā/a/-.k
Address 112 DUNPHY DRIVE
Address 2
Address 3
City FLORENCE
State MA Zip Code 01062
Total Volume:
Septic Holding Tank ā Leach Tank F Cesspool [7] Grease Trap
Date of Previous Pumping, If Known:
Waste Received at Licensed Facility:
Licensed Facility Phone Number: \ V -R I
Town:
Misc Comments:
Driver:
Created 2/11/2020 at 9:31:21 AM Page 1 of 1