HomeMy WebLinkAboutLOT B - SWG Pumpers Report / Maintenance - 9/27/2000 (ck
Mason County Environmental Health Department
Septic Tank Pumping Report Form
Property Owner/Mailing Address /l� (itf, ] J Z`^C• 1 o )‹. e.S g 2_
Site Address •/VE je- Gvy '3 gtL-/9/.e
Tax Parcel Number 33Z .50 al Legal Description 44 Of 0 6s'
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(Putper's Finding's) All items must be filled out completely, circle answer as needed.
Septic Tank Information
1) Tank pumped and (spectec� es or no
Effluent level: highs / norma / low
2) Tank size: //5 gallons
3) Tank construction: 6ianufacture)or home made
Tank material : metal wood copefdEt fiberglass other
4) How many compartments? single or(dod5T3
5) InYet Baffle condition: atisfacto / needs repair
Outlet Baffle condition: cto / needs repair
Center Baffle condition: isfacto needs repair / not applicable
Effluent filter cleaned: yes / no / of app is
6) Does the system have a pump chamber? yes / ®° / unknown
Did the pump chamber need to be pumped? yes / no / of applicable..."
7) Tank condition: damaged / g6o
Were the tank or the baffles repaired? yes / e / not applicable
Solids level (optional) : Sludge / Scum
Drainfield condition: backflow into the tank / seepage in drainfield
6o observed problems)
8) Location where septage was disposed • -- —_
9) Abnormal observations: (If repairs were made, please explain)
Findings and determinations of this inspection reflect conditions as they existed on the day the septic tank
was pulped. No claim is made by this company, either expressed or implied, concerning success or failure or the
septic system.
Signature of certified pumper Date /27/oo
Name of Company C/ 1 C / /r