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Pumping Report <br /> Sewer Services Inc. Lic: 2502 <br /> Date Serviced: % $/4..3 Driver: Type: Residential Commercial <br /> Scheduled Maintenance: Emergency Services: Start time: <br /> Stop time: <br /> Name: Phone: <br /> Address: �.��r© ►,,,�`;. �/- 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 too° Serv►cec <br /> Scum 0 <br /> Sludge a/a <br /> %full Lf% <br /> Operating Depth <br /> Access used /11H H <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 -recast Block - oncret Plastic - Other <br /> Filter: Yes 40 Type of system. - Gravity - Holding Tank - Elevated Trench/Bed <br /> Type of waste: ores s' - 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: WOE Electrical condition: 3 eie - <br /> Are all of the covers securely replaced? es No, <br /> Safety concerns: --- <br /> Disposal site: uoa-te(.- uvn <br /> Next recommended pumping: .)_3ay ozcs Length of hose required: 1 0 <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. Billing Information <br /> Many different variables determine how often Pumping (first 1000 gal.): Li 40, <br /> a tank needs pumping: Additional gallons : -- <br /> Servicing Pump Tank: P5 00 <br /> ❑ 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 /> ❑ 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 /> Filing Fee Fuel. Surcharge /l. co <br /> State Certified <br /> Payment Method: Total Due: /C a",.:. <br /> None - Cash - Check (# ) <br /> 25648 200th St • Belle Plaine, MN 56011 • 952-873-3292 <br />