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Pumping Report <br /> Sewer Services Inc. tic:2502 <br /> Date Serviced: (1-2. f fi Driver: _,,f/f\- Type:Residential/ Commercial <br /> Industrial <br /> Scheduled Maintenance Emergency Services: Start time: t4 i S <br /> Stop time: C <br /> C_,, <br /> Name: 1j0111 Y1 k, VCIC“,._ Phone: 6,i2.....(16,(1- <br /> Address: a I go C e YY;Aaye. {.auu City: 6{Og <br /> Did you measure the accumulatifdn of scum and sludge? Yes o pumped regardless <br /> Tank 1 Tank 2 Tank 3 Tank 4 Pretreatment Pump Tank <br /> Gallons Billed ),`304 )13°° 4-x-) <br /> Scum <br /> Sludge <br /> %full <br /> Operating Depth <br /> Access used ,n1qr// N1 f/ <br /> Depth to lid ?''C.(.. ,_ 6 /? <br /> 1 ,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 Pr ' Block - Come) Plastic - Other 4 <br /> Filter: Yes No rte --) Type of system: /Acirj <br /> Type of waste oT) mestic.' Holding - Co mercial - Industrial - Flammable waste trap <br /> Are tanks opera mg t designed depth? e)No, <br /> Did you obserrve sewage discharging onto the ground surface N4Yes, <br /> �(f � Electrical condition: rj <br /> Pump Size: <br /> Are all of the covers securely replace . es No, <br /> Safety concerns: <br /> Disposal site: LO ye C <br /> Next recommended pumping: Ali/.P') Other: <br /> Comments: <br /> Sewer Services Inc.25648 200th Street-Belle Plaine,MN 56011-952-873-3292 <br /> Septic tanks should be pumped elJery 1 to 3 years. Billint?Inlformation <br /> Many different variables determine how often Pumping(first 1000 gal.): ,,Og 11 <br /> a tank needs pumping: Additional gallons($80.00 per 1000 gal.):__/6/P-v <br /> Exposing Manholes(12"deep or less no charge): <br /> ❑ Type and age of system Excessive Distance(more than 120•): <br /> ❑ Number of people in the house Excessive Grade(more than 20'total lift): <br /> ❑ Garbage disposal Riser: <br /> o Tank history Emergency Charge: <br /> Materials: <br /> PUMP REPLACEMENTS, Labor: awl 1l1Gt11.ee- 399 <br /> INSPECTIONS & REPAIR Permit: <br /> Filing Fee: $5.00ao <br /> Payment Method: Total Due: <br /> State Certifie <d None -Cash -Check (# ) <br /> Credit Card= <br /> 25648 200th St•Belle Plaine,MN 56011 •952-873-3292 Type # Exp. <br />