HomeMy WebLinkAboutSWG Pumpers Report / Maintenance - 5/23/2002 Mason County Environmental Health Department
P.O. Box 1666
Shelton,Wa.98584
(360)427-9670 Belfair: 275-4467
Septic Tank Pumping Report Form
(Pumper's Findings) All items must be filled out completely, circle answer as needed.
Property Owner: DEL LoR.A.A l N E 7INC:WA 1-.1--
Mailing Address 913y CO5T4 AUt^ 3E. SAMMfM tS N WASH cl 60'15
Site Address: /p°Z ?4 I //O�l-/5/ I( / D) _FE L j 4 t' ,(
Tax Parcel Number(if known) 322311 -50-OOOO° # 00010
1) Tank�d inspectedsbr no
Effluent level: hig%Vr•1jti b low
2) Tank size: gallons
3) Tank constructi or home-made
Tank material: metal wood —sangete)fiberglass other
4) How many compartment? Single o ou •
5) Inlet Baffle condition: sati ••«•_• needs repair
Outlet Baffle condition: VA ..,•: needs repair
Center Baffle condition: • . •. /needs repair/not applicable
Effluent filter cleaned: /no/not applicable
6) Does the system have a pump chamber •/no/unknown
Did the pump chamber need to be pumped? yesdlal not applicable
7) Tank condition: damaged o
Were there repairs made to the tank or the baffles? Yese-)If yes, please ex lain below.
Drainfield condition: backflow into the tank/seepage in drainfield no observe problems
8) Location where septage was disposed /1/�
. .
9) A}l normal otbservatio (If repairswere made, please explain) SUL,ll� /vim s�'f f—1 C /,1/. vS l t L / t'uR Q[N4 .
Findings and determinations of this inspection reflect con ions as they existed on the day the septic tank was pumped.
No claim is made by this company,ei r exprcsse or• plied,conce ing uccess or failure of the septic system.
Signature of certified pumper )11"--
• Date s3.--4,3/4
Albert P. D ouillard
Arrow Septic Service
N.E. 1120 Old Belfair Hwy.
Belfair, Wa. 98528
(360)275-4685 1-800-939-0465