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sewer Services Inc. <br />Date Serviced: i ),6 - a S Driver: <br />scheduled Maintenance: <br />T3�3�i�i.3rlwlw <br />Pumping Report <br />Lic: 2502 <br />Services <br />Name: 7 i t <br />Address: ao5 2 <br />Did you measure the accumulation of scum and sludge? <br />start time: 5 <br />Stop time: r7 I a <br />Phone: <br />City: J r�lJ <br />Y No, pumped regardless <br />1refuse 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 Mine. R. 7080.24S0 and 7082.0600 <br />Owner's Sigr=t _ <br />Tank Typ - Pr Giock - Concret - Plastic - Other <br />Filter: Yes No Type of system: Mound - Gravity - Holding Tank -Elevated Trenchl6ed <br />Type of waste:amesti - 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 Yes, <br />Pump Size: Eledrica condition: o0 <br />Are all of the covers securely replace a No, <br />Safety concerns: rt r—x <br />Disposal site. 611A Q L/t <br />Next recommended pumping: Length of hose required: <br />Sewer 5,�,vires Inc. 25648 200th Street - Belle Plaine, MN 56011- 952-873-3292 <br />Septic tanks should be pumped every 1 to 3 years. <br />Many different variables determine how often <br />a tank needs pumping. <br />o Type and age of system <br />❑ Number of people in the house <br />❑ Garbage disposal <br />❑ Tank history <br />PUMP REPLACEMENTS, <br />INSPECTIONS & REPAIR <br />State Certirted <br />25649 200" St • Belle Plaine, MN 56011 •952-873-3292 <br />Mine Information <br />Pumping (first 1000 gal.): <br />Additional gallons : 1 <br />Servicing Pump <br />Exposing Manholes p2" dxP oc less no cha gc): <br />Excessive Distance tmncemaa 120'}: <br />Excessive Grade (m— lha 20' mtai lift): <br />Riser. <br />Emergency Charge: <br />Materials: <br />Labor: <br />Permit: <br />Filing Fee 9,e FuelSurchar e <br />Payment Method: Total Dueg 6 �� <br />None - Cash - Check _ (# ) <br />Tank 1 <br />Tank 2 Tank 3 Tank 4 Pretreatment <br />Pump Tank <br />C Cec <br />r0perating <br />Access used <br />G <br />1refuse 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 Mine. R. 7080.24S0 and 7082.0600 <br />Owner's Sigr=t _ <br />Tank Typ - Pr Giock - Concret - Plastic - Other <br />Filter: Yes No Type of system: Mound - Gravity - Holding Tank -Elevated Trenchl6ed <br />Type of waste:amesti - 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 Yes, <br />Pump Size: Eledrica condition: o0 <br />Are all of the covers securely replace a No, <br />Safety concerns: rt r—x <br />Disposal site. 611A Q L/t <br />Next recommended pumping: Length of hose required: <br />Sewer 5,�,vires Inc. 25648 200th Street - Belle Plaine, MN 56011- 952-873-3292 <br />Septic tanks should be pumped every 1 to 3 years. <br />Many different variables determine how often <br />a tank needs pumping. <br />o Type and age of system <br />❑ Number of people in the house <br />❑ Garbage disposal <br />❑ Tank history <br />PUMP REPLACEMENTS, <br />INSPECTIONS & REPAIR <br />State Certirted <br />25649 200" St • Belle Plaine, MN 56011 •952-873-3292 <br />Mine Information <br />Pumping (first 1000 gal.): <br />Additional gallons : 1 <br />Servicing Pump <br />Exposing Manholes p2" dxP oc less no cha gc): <br />Excessive Distance tmncemaa 120'}: <br />Excessive Grade (m— lha 20' mtai lift): <br />Riser. <br />Emergency Charge: <br />Materials: <br />Labor: <br />Permit: <br />Filing Fee 9,e FuelSurchar e <br />Payment Method: Total Dueg 6 �� <br />None - Cash - Check _ (# ) <br />