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a <br />sewer services Inc. <br />Date Serviced: ;' <br />Driver: <br />Pumping Report <br />Lic: 2502 <br />Type: Residential Commercial <br />Scheduled Maintenance: Emergency Services: Start time: 1. <br />Stop time: //' VI <br />Name: r.. • �i,: i <br />Address: <br />Did you measure the accumulation of scum and sludge? <br />Phone: <br />City:yo•> y -/'r <br />YesNo_" nim-pe,�{��gardl_ less <br />Tank 1 <br />Gallons Billed <br />Tank 2 <br />ITank 3 <br />ITank 4 <br />Pretreatment <br />Pump Tank <br />Scum <br />Sludge <br />F <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 - Co.ncrete._- 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:,,_ el <br />s , , %%. Electrical condition: <br />Are all of the covers securely replaced? 'Yes No, <br />Safety concerns: <br />Disposal site✓ i . % �, / / J• <br />Next recommended pumping: _ V,, f Length of hose required: / l),; :, <br />Comments/Troubleshooting/Repairs: I'�� ;: l j 1. ` �, 11A, j <br />Lo ation of tanks inyard: [i,% f i <i } l ' ' IV,,✓t✓ > <br />r <br />v.1, �1' k," Sewer Services Inc. 25648 200th Street - Belle Plaine, MN 56011- 952-873-3292- <br />Septic <br />52-873-3292 <br />Septic tanks should be pumped every 1 to 3 years. <br />!hairy different variables determine how often <br />a tank deeds pumping: <br />Ll 7,11pe and apre nf cvetar.. <br />Billie! Information <br />Pumping (first 1000 gal.): 11,9 r - <br />Additional gallons (d er 1000 gal.): 178,E <br />Servicing Pump Tank g� <br />