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Sewer Services Inc. <br />Date Serviced: S 1 2( Driver: <br />Pumping Report <br />lit: 2502 <br />Type: Residential Commercial <br />Scheduled Maintenance: Emergency Services: Start time: <br />Stop time: <br />Name: <br />Address: <br />Did you measure the accumulation of scum and sludge? <br />Phone: <br />City: <br />Yes No, pumped regardless <br />I , refuse to allow the removal of the solids and liquids through <br />the maintenance hole. I understand that removal of solids and liquids through other access <br />points is not considered a compliant method of solids removal and does not fulfill the solids <br />removal requirements of Minn. R. 7080.2450 and 7082.0600 <br />Owner's Signature <br />Tank Type - Precast - Block - Concrete - Plastic - Other <br />Filter: Yes No Type of system: Mound - Gravity - Holding Tank - Elevated Trench/Bed <br />Type of waste: Domestic - Holding <br />Are tanks leaking above or below flow line? Yes No If yes, where: <br />Did you observe sewage discharging onto the ground surface? No Yes, <br />Pump Size: Electrical condition: <br />Are all of the covers securely replaced? Yes No, <br />concerns: <br />Disposal site: <br />Next recommended pumping: Length of hose required: <br />Comments/Troubleshooting/Repairs: <br />Location of tanks in <br />Sewer Services Inc. 25648 200th Street - Belle Plaine, MN 56011 - 952-873-3292 <br />Septic tanks should be pumped evert / to 3 tears, <br />Many different variables deternnine how often <br />a tank needs pumping: <br />.j Tfpe and age of 'ststem <br />Number of people in the house <br />Garbage disposal <br />j Tank history <br />PUMP REPLACEMENTS, <br />INSPECTIONS & REPAIR <br />State Certified <br />5648 200"' St • Belle Plaine, MN 56011 • 952-S' <br />Billint., Information <br />P11111ping (first MOO C;al.): <br />Additional gallons (slrs.ut)rkr <br />Seri icing Ptinlh "hank (sss.txll: _ <br />Exposing Manholes ( 12,, %k%rpa(kvtwrhsgtrl: ` -- <br />E wessiv e DiS4111ce Maar thm, 12(r 1: <br />— <br />Ewessive Grade tin„tm than 2W total ha►: — <br />Rizer: -- --- <br />Ernergency Charge: - <br />Materials: — <br />l.ahur: <br />Permil: _ <br />111,111lig 1 Le S% (IIT- Fuel Surohurge $S. 11t)Puy mo nl Metl1�>?I-- lout► Due: ,1 / <br />Noone - Cash - Check to <br />Tank 1 <br />Tank 2 <br />Tank 3 <br />Tank 4 <br />Pretreatment <br />Pump Tank <br />Gallons Billed <br />Scum <br />- -- — <br />— — <br />Sludge <br />— <br />%full <br />Operating Depth <br />Access used <br />Depth to lid <br />I , refuse to allow the removal of the solids and liquids through <br />the maintenance hole. I understand that removal of solids and liquids through other access <br />points is not considered a compliant method of solids removal and does not fulfill the solids <br />removal requirements of Minn. R. 7080.2450 and 7082.0600 <br />Owner's Signature <br />Tank Type - Precast - Block - Concrete - Plastic - Other <br />Filter: Yes No Type of system: Mound - Gravity - Holding Tank - Elevated Trench/Bed <br />Type of waste: Domestic - Holding <br />Are tanks leaking above or below flow line? Yes No If yes, where: <br />Did you observe sewage discharging onto the ground surface? No Yes, <br />Pump Size: Electrical condition: <br />Are all of the covers securely replaced? Yes No, <br />concerns: <br />Disposal site: <br />Next recommended pumping: Length of hose required: <br />Comments/Troubleshooting/Repairs: <br />Location of tanks in <br />Sewer Services Inc. 25648 200th Street - Belle Plaine, MN 56011 - 952-873-3292 <br />Septic tanks should be pumped evert / to 3 tears, <br />Many different variables deternnine how often <br />a tank needs pumping: <br />.j Tfpe and age of 'ststem <br />Number of people in the house <br />Garbage disposal <br />j Tank history <br />PUMP REPLACEMENTS, <br />INSPECTIONS & REPAIR <br />State Certified <br />5648 200"' St • Belle Plaine, MN 56011 • 952-S' <br />Billint., Information <br />P11111ping (first MOO C;al.): <br />Additional gallons (slrs.ut)rkr <br />Seri icing Ptinlh "hank (sss.txll: _ <br />Exposing Manholes ( 12,, %k%rpa(kvtwrhsgtrl: ` -- <br />E wessiv e DiS4111ce Maar thm, 12(r 1: <br />— <br />Ewessive Grade tin„tm than 2W total ha►: — <br />Rizer: -- --- <br />Ernergency Charge: - <br />Materials: — <br />l.ahur: <br />Permil: _ <br />111,111lig 1 Le S% (IIT- Fuel Surohurge $S. 11t)Puy mo nl Metl1�>?I-- lout► Due: ,1 / <br />Noone - Cash - Check to <br />