798 pumping report System Pumping Report
Wastewater Removal
239 A Greenfield Road
South Deerfield,MA 01373
Phone 413-665-3969 Fax 413-665-7358
****** This report will be sent to the BOARD OF HEALTH within 15 DAYS ******
Permit# IDYL - MA License# Date of Pumping /1 I-1/\1
Address 798 NORTH KING STREET
Property Owner MIKE CYCZ Address 2
Home Phone 413-584-4974 Address 3
Bus Phone City NORTHAMPTON
Cell Phone State MA Zip Code 01060
Total Volume: 1.SC0
Tank Size: 1500 GAL W/ FILTER
Concrete
Good
Tank Location
Septic Holding Tank Leach Tank Cesspool Grease Trap
Date of Previous Pumping, If Known: k„0 11J q I S
Waste Received at Licensed Facility: qC .x (DF L
Licensed Facility Phone Number: Y)-` Q( '
/-'
Town: `� ` \)\a\
Misc Comments:
Driver:
we
Created 7/23/2018 at 11'41:58 AM Page 1 of 1