HomeMy WebLinkAboutSeptic Pump 4/23/20 YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY
(1/10 System Identification
Town Pumped / Telephone#
No. - Street (r iJ t
Village
Owner's Name: (�:L)d c /7 (di1 a
Mail Address:
(if different)
Use: Residence Business ,/ Name
u
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
Gallons Pumped: Comment:
Pumped By
Licensed Pumper: y(a)
Li Z 3 2 o IG
Truck License No.: Date:
•
Driver Name:
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date:
Received: Gallons Ticket#