HomeMy WebLinkAboutSeptic Pump 4/22/20 YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY
�. System Identification
Ot4CUMn
Town Pumped Telephone#
r. 6t110
No. Street
Village
Owner's Name: f ) ri
Mail Address:
(if different)
Use: Residence Business Name
Reason Pumped: Maintenance Q 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
/00
-
Gallons Pumped: Comment:
Pumped� By
Licensed Pumper: `5{oJc n V,t
Truck License No.: ., Date: . Z Z Z02Cj
Driver Name:
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date:
Received: Gallons Ticket#