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Sewer Services Inc.J <br />Date Serviced: (p� 71 a4 Driver: <br />Scheduled Maintenance: <br />Name <br />Address: � a,l C, � <br />Pumping <br />Lic: 2502 <br />Em <br />Report <br />Services: <br />Did you measure the accumulation of scum and sludge? <br />Type:<r%_: dent a Commercial <br />Start time: 67J Z7 L <br />Phone: <br />3 <br />Stop time: / t7 : <br />F ' I> _ 1e.V8c3? <br />No, pumped regardless <br />Tank 1 <br />Tank 2 <br />Tank 3 <br />Tank 4 <br />Pretreatment <br />Pump Tank <br />Gallons Billed <br />Scum <br />(" <br />Sludge <br />1, <br />'' <br />I - <br />% full <br />cl"In <br />L <br />Operating Depth <br />r -- <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 />N f <br />Type of waste: po mestic - Holding <br />Are tanks leaking above or below flow line? Yes IVo� If yes, where: <br />Did you observe sewage discharging onto the ground surface? o Yes, <br />Pump Size: �"% Electrical condition: <br />Are all of the covers securely replaced?(Yes, No, <br />Safety concerns: ; \ , b <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 />Many different variables determine how often <br />a tank needs pumping: <br />❑ Type and age of system <br />❑ Number of people in the house <br />❑ Garbage disposal <br />❑ Tank history <br />PUMP REPLACEMENTS,RIR <br />INSPECTIONS & <br />=Statc Certified i::: :: <br />25649 20011, St • Belle Plaine, MN 56011 • 952-873-3292 <br />Billing Information <br />Pumping (first 1000 gal.): `" <br />Additional. gallons <br />Servicing Pump Tank: <br />EXposing Manholes (12" deep or less no charge): <br />1 xcessive Distance (more than 120'): <br />EXC8SS1Ve Grade (more than 20' total lift): <br />Riser: <br />Emergency Charge: <br />Materials: 0 � <br />Labor: <br />Permit: __ <br />filing Fee Jt`%a JD <br />Payment Method: <br />- Cash <br />None <br />Fuel Surcharge � �(.�00 <br />Total Due: � i <br />- Check (# ) <br />