HomeMy WebLinkAbout2024 septic pumping report 1760 ShorelineHENNES SEPTIC PUMPING, LLC john@hennesseptic.com
Individual Sewage Treatment System (ISTS) Pumping Record {� 952-403-0058
Owner k� Rti �WW. WV Address 7 N Y' ��t1i^� /Ll
PumperNo. of Tanks Pumped Total Gallons Pumped
Check all that apply AResidential ❑ Commercial Mental
--Septic ❑ Holding Pump Chamber ❑ Cesspool ❑ Abandoned ❑ Other:
Condition of Baffles (baffles must be inspected) XAcceptable ❑Unacceptable ❑Replaced Baffles
Reason for pumping.? Water tight tank? Alves ❑ No
Disposal Location (be specific)
Any tank leakage below or above the operating depth? -❑ Yes f, No
Pumped From: XMaintenance Hole ❑ Removed Tank Lid (stave, for example) ❑ Inspection Pipe (see below)
I have been informed about the correct tank cleaning procedures and understand that I risk having my system fail prematurely if the tank is not
pumped through the Maintenance Hole / Tank Lid to enable the removal of solids.
Signature of Owner / Owner's Agent Reason for not pumping through the Maintenance Hole / Tank Lid
Safety Concerns / Repairs
Pumper/ Inspector Signature �� Dater
Only one permit is needed per ISTS. If there is more than one ISTS on a property, submit a separate permit for each ISTS. Submit a:permit whenever
a tank is pumped for abandonment. Pumping the tank does not constitute a compliance inspection.