HomeMy WebLinkAbout4640 North Arm Drive West - Septic Pumping ReportMN MPCA
INDIVIDUAL SEWAGE TREATMENT SYSTEM (ISTS) PUMPING RECOn
Owner Address
Pumper
No. of Tanks Pumped Total Gallons Pumped
Check all that apply: qResidential LJ commercial L]Rental
'* Septic LJ Holding gPump Chamber LJ Cesspool Ll Abandoned Ll Other:
Condition of Baffles (baffles must be inspected) *Acceptable LJ Unacceptable LIReplaced Baffles
Reason for pumping?
Disposal Location (be specific)
Water tight tank? KYes Ll No
Any tank leakage below or above the operating depth? Ll Yes No
Pumped From: �Maintenance Hole El Removed Tank Lid (stave, for example) 0 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
Safety Concerns / Repairs
Pumper/ Inspector Signature
Reason for not pumping through the Maintenance -Hole /Tank Lid
Date
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,
cz
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