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Sewer Services Inc. Lic: 2502 <br />Date Serviced: Driver: <br />Residential Commercial <br />Scheduled Maintenance: Emergency Services: Start time: <br />Stop time: <br />Name <br />t <br />f � <br />Address: <br />Did you measure the accumulation of scum and sludge? <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 />fullkt <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 />......... . <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 I to 3 years. <br />Many different variables determine how often <br />a tank needs pumping: <br />o Type and age of system <br />❑ Number of people in the house <br />❑ Garbage disposal <br />❑ Tank history <br />PUMP REPLACEMENTS, <br />INSPECTIONS & REPAIR <br />State Certifiet/7 <br />25648 200th St - Belle Plaine, MN 56011 • 952-873-3292 <br />Billing Information <br />Pumping (first 1000 gal.): <br />Additional gallons <br />Servicing Pump Tank: �r.. <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 />