HomeMy WebLinkAboutSeptic Pump 4/23/20 YARMOUTH - DENNIS SEPTAGE TREATMENT FACILITY
\/ System Identification
U i r4o L,
Town Pumped Telephone#
No. Street I G1'5 l-e , (�(le)
Village
Owner's Name: (.?-nA-5" j/"/� r���Y c:O
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
Gallons Pumped: Comment:
Pumped By
Licensed Pumper:
Truck License No.: Date: ( O(C)
Driver Name: f�
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date:
Received: Gallons Ticket#