HomeMy WebLinkAboutSWG Pumpers Report / Maintenance - 9/27/2000 ft
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Mason County Environmental Health Department
Septic Tank Pumping Report Form
Property Owner/Mailing Address /‹), 3..1-i j L"NC. l X L 5 8 L
Site Address AiE .q t /Ail 3 IJZLJ2//e
Tax Parcel Number 33Z SO Zl Legal Description Gor ''13` of S P l(os(
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(Pumper's Finding's) All items must be filled out completely, circle answer as needed.
Septic Tank Information
1) Tank pumped and (nspecte or no
Effluent level : high / norma / low
2) Tank size: /0-4p gallons
3) Tank construction: anufacturtil)or home made
Tank material : metal wood copexet) fiberglass other
4) How many compartments? single or GX5-1r
5) Inret Baffle condition: atisfacto / needs repair
Outlet Baffle condition: to / needs repair
Center Baffle condition: atisfacto needs repair / not applicable
Effluent filter cleaned: yes / no / of app is
6) Does the system have a pump chamber? yes / ®o / unknown
Did the pump chamber need to be pumped? yes / no / of applicably
7) Tank condition: damaged /( o
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
no 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 tint.
was pumped. No claim is made by this company, either expressed or implied, concerning success or failure of the
septic system.
Signature of certified pumper Date 0741
Name of Company (�// 1 C /7-1 44-