HomeMy WebLinkAboutBLD2007-00612 - SWG Pumpers Report / Maintenance - 4/18/2007 Septic Tank Pump & Service Reports
Residential 0 Motel ❑Food Service Restaurant
❑ RV Park ❑Youth Camp ❑Other, Please Describe: AR
' n
❑Campground ❑Mobile Home Park Space#
Property Owner ��f,� 5 Phone#
Business name(if applicable)
Mailing address City State zip
Site address d 1 LL City ,T7 �-�-;
Tax parcel# 7i 7 -- ��_ _ EZ
SEPTIC TANK
Tank Size:1 d 6 Gallons #of Compartments: Tank Construction: ®'Manufactured ❑Home Made
Tank Material: ❑ Metal ❑WW'ood WConcrete ❑ Fiberglass ❑Other
Effluent Levet 21es
* h 9Normal ❑ Low Tank Condition: atisfactooryy O Needs Repair
Tank Pumped:: ❑ No Were repairs made to the tank? ❑Yes 2 o
If yes,please explain:
BAFFLES
Inlet Baffle Condition: 114atisfactory ❑ Needs Repair
Outlet Baffle Condition: B Satisfactory ❑ Needs Repair
Center Baffle Condition: ®'Satisfactory �Fot
ds Repair ❑ Not Applicable
Effluent Filter Cleaned? ❑ Yes ❑ No Applicable
Were repairs made to the baffles? ❑ Yes 91110
If yes,please explain:
PUMP OR SURGE TANK ❑ Yes ®'No If yes, tank size: Gallons
Were repairs made to the pump or surge tank? ❑ Yes ❑ No
If yes,please explain:
SEPTAGE
Depth of Floating Mat. 1st Compartment: AC12 2nd compartment Pump Tank
Depth of Sludge: 1 st Compartment: 4 2nd compartment Pump Tank
Total Gallons Pumped oZv'n Disposal Facility. 2 iorecycle ❑ Other:
General Comments:
Date Pumped �8 Q e omme de Next Pumping Date
Certified Pumper Signature e Company Name o—t
Findings and determinations of this inspection reflect 4nditions as they existed on the day the septic tank was pumped.No claim is made
by this company, either expressed or implied, concerning success or failure of the septic system.
Mason County Department of Health Services•426 W Cedar• Mason County Building III
PO Box 1666• Shelton, WA 98584• (360) 427-9670 ext. 352
White copy-Health Department Yellow copy-- Pumper Pink copy-Owner