377 Pump Report 2019 System Pumping Repon s Wastewater Removal
239 A Greenfield Road
South Deerfield, MA 01373
Phone 413-665-3989 Fax 413-665-7358
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****** This report will be sent to the BOARD OF HEALTH within 15 DAYS ******
Permit#1X(A)ADN MA License# Date of Pumpinga-1,-/-d
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Address 377 COLES MEADOW ROAD
Property Owner CHUONG DINH Address 2
Home Phone (413)559-0942 Address 3
Bus Phone City NORTHAMPTON
Cell Phone State MA Zip`` Code 01060
Total Volume: 1 J C)
Tank Size: 1500 GAL 2 COMP. W/FILTER
Concrete
Good
Tank Location MAP ON FILE U I DER PATIO
Septic Holding Tank [-] Leach Tank ❑ Cesspool Grease Trap
Date of Previous Pumping, If Known: ) p )
Waste Received at Licensed Facility:
Licensed Facility Phone Number. �
Town:
Misc Comments:
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Driver:
Created 7/17/2019 at 2:1,6:59 PM Page 1 of 1