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Pumping Report <br />Sewer Services Inc. Lic: 2502 <br />Date Serviced: Driver: Type: Residential Commercial <br />Scheduled Maintenance: <br />Name: <br />Address: <br />Emergency Services: <br />Did you measure the accumulation of scum and sludge? <br />Start time: <br />Stop time: <br />Phone: <br />City: <br />Yes 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 />Sludge <br />% full <br />Operating Depth <br />Access used <br />Depth to lid <br />I ' 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 />Type of waste: Domestic - 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? No Yes, <br />Pump Size: Electrical condition: <br />Are all of the covers securely replaced? Yes No, <br />Safety concerns: <br />Disposal site: <br />Next recommended pumping: Length of hose required: <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. <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 />:j Garbage disposal <br />Tank history <br />PUMP REPLACEMENTS, <br />INSPECTIONS & REPAIR <br />FState Certified <br />7 <br />25648 200" St • Belle Plaine, MN 56011 • 952-873-3292 <br />BillinLy Information <br />Pumping (first 1000 gal.): <br />Additional gallons : <br />Servicing Pump Tank: <br />Exposing Manholes (12" deep or less no charge): <br />Excessive Distance (more than 120'): <br />Excessive Grade (more than 20' total lift): <br />Riser: <br />Emergency Charge: <br />Materials: <br />Labor: <br />Permit: <br />Filing Fee <br />Payment Method: <br />None - Cash <br />Fuel Surcharge <br />Total Due: _ <br />- Check (# <br />