HomeMy WebLinkAboutSeptic Pump 6/7/22 YARMOUTH - DENNIS SEPTAGE TREATMENT FACILITY
'A $_ sy tem Identification
Town Pumped Telephone#
n _11 ff J
No. Street Li? i3 ( t-+ LA-A
A
Village
Owner's Name: 100 l�',1 '1 W 4r.' K.
Mail Address:
(if different)
Use: Residence Business Name
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations
Facility Septic Tank ✓ Cesspool Converted Cesspool
Pumped: Holding Tank Leach Facility Grease Trap
Cover within 1 foot? Yes
�,_ No Back Flow? Yes — No
Q
Gallons Pumped: / t�'�' Comment:
Pumped By Licensed Pumper: ` 1 I / C C.
Li /I L E 6J
I
Truck License No.: Date:
F
Driver Name: T r
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date: 4 - 7-
Received: Gallons Ticket#