15 INTERVALE ROAD C.Sept I c�
I
D&G Septic Tank Service
327 Asbury Street Date:
S. Hamilton, MA 01982
_ P
978-774-7491 Technician:
CUSTOMER SERVICE REP Hose len h:
System Owner: 6)0 rl Q �JPU rl lob Site/Contact:
Address: /5 14il-e rVa l G ed Address: SFR 0 4 200
6al6m , M4 n 1q-3-0
Phone: q-1 ys --7 LK->- D S 1 S Phone:
BEl11RB OF HFA►-tH
SYSTEM FUNCTION CHECK & PUMPING REPORT
❑ Septic Tank: ❑single ❑double compartment Filter present: ❑Yes Ct�1Vo
9-"Cesspool: El overflow cesspool ❑ Cleaned ❑ Replaced ❑ Installed
Size of tank gal Type of filter:
Actual amount pumped 1 /UOQ gal Condition:
Scum layer(acceptable range 1-2") 1 in
Sludge depth(acceptable range 5-10") in Comments:
Liquid level QI)� (011dt Or/
❑Overflow Tank / ❑Overflow Cesspool
Size of tank galDn�t �� s7S
2 r
ty
Actual amount pumped gal J �� rC�00:i-
Liquid level
Condition
YES NO
Tank structure We recommend that you pump Your septic
Breakout or ponding v system every: 1 2 3 4 5 years.
Liquid level above inlet invert *Thank you for your continued patronage, we
Liquid level above outlet invert v really appreciate your business! Our goal is to
Tee or Baffles missing or broken @ inlet v leave our customers satisfied and delighted by
Tee or Baffles missing or broken @ outlet ✓ providing exceptional service. Please call with
*YES indicates there is a problem,NO indicates there is no problem any questions or concerns.
PREVENTATIVE MAINTENANCE PERFORMED
QTY. DESCRIPTION PRICE AMOUNT
TOTAL
Pa ment amt received $ ❑ Cash ❑ Check #: Bal:
For office use only please. DkInvoi ent re ❑ Payment applied ❑ Pumping report sent to BOYN
Date:�0? Date: Date: