110 Title 5 Pupmping Record 2010 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 DAYS/ ******
Permit#RNItxo9-d7/ MA License# Date of Pumping c�1 % /U
Property Owner IRVING WEISENTHAL
Home Phone
Bus Phone
Cell Phone
Tank Size:
(413)341-3191
(347)661-0662
1500 GAL
Concrete
Good
Address 110 MORNINGSIDE DRIVE
Address 2
Address 3
City FLORENCE
State MA Zip Code 01062
Total Volume: ..57..)0
Tank Location MAP ON BACK
Septic >'Holding Tank Leach Tank I Cesspool ❑ Grease Trap f
Date of Previous Pumping, If Known: /[°'l�
Waste Received at Licensed Facility: `-�I -r-' W'i2
Licensed Facility Phone Number: 7 - 9 - 9700'
Town:
t 7
Misc Comments:
Driver:
Created 12!7/2010 at 10:29:17 AM
x117
Page 1 of 1