628 System Pump Report 11-8-19System Pumping Report
Greg'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 # vVv .) D jq MA License #
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Property Owner JEFF GNAGEK
Home Phone (413) 387-9235
Bus Phone
Cell Phone
Tank Size: 1500 GAL?
Concrete
Tank Location
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Date of Pumping
Address 628 WESTHAMPTON ROAD
Address 2
Address 3
City NORTHAMPTON
State MA Zip Code 01062
Total Volume:
Septic Holding Tank ❑ Leach Tank ❑ Cesspool [] Grease Trap ❑
Date of Previous Pumping, If Known:
Waste Received at Licensed Facility:
Licensed Facility Phone Number:
Town:
Misc Comments:
Driver:
Created 11/14/2019 at 1:58:44 PM Page 1 of 1