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Pumping Report <br /> Sewer Services Inc. Lic: 2502 <br /> Date Serviced: Driver: Type: Residential Commercial <br /> Scheduled Maintenance: Emergency Services: Start time: <br /> Stop time: <br /> Name: Phone: <br /> Address: City: <br /> Did you measure the accumulation of scum and sludge? Yes No, pumped regardless <br /> Tank 1 Tank 2 Tank 3 Tank 4 Pretreatment Pump Tank <br /> Gallons Billed <br /> Scum <br /> Sludge <br /> %full <br /> Operating Depth <br /> Access used <br /> Depth to lid <br /> , 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 /> Safety concerns: <br /> Disposal site: <br /> Next recommended pumping: Length of hose required: <br /> Comments/Troubleshooting/Repairs: <br /> Location of tanks in yard: <br /> Sewer Services Inc. 25648 200th Street - Belle Plaine, MN 56011 - 952-873-3292 <br /> Septic tanks should be pumped every 1 to 3 years. <br /> Billine Information <br /> Many different variables determine how often Pumping(first 1000 gal.): <br /> a tank needs pumping: Additional gallons ($130.00 per 1000 gal.): <br /> Servicing Pump Tank($6a,0a): <br /> o Type and age of system Exposing Manholes(12"deep or less no charge): <br /> ❑ Number of people in the house Excessive Distance(more than 120'): <br /> o Garbage disposal Excessive Grade (more than 20'total lift): <br /> ❑ Tank history Riser: <br /> Emergency Charge: <br /> PUMP REPLACEMENTS, Materials: <br /> INSPECTIONS & REPAIR Labor: <br /> Permit: <br /> State Certified Filing Fee $7.00 Fuel Surcharge $5.00 <br /> _ , <br /> Payment Method: Total Due: /Uth . 1 CI <br /> None - Cash - Check (# j <br /> 25648 200t(' St • Belle Plaine, MN 56011 • 952-873-3292 <br />