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+ Lo raikq l NE T1A)6W4 Li--
Mailing Address p yti3yz.05Th AVG. SE. .3AMM/�MtSt-1 WA5N t3CI5
Site Address: /pZ a ( o /-/ / ��, E L r4( ► -
Tax Parcel Number(if known) 32239 -50—0000°) ,r Opp 1 0
I) Tank�d inspectedcbr no
Effluent level: hig m low
2) Tank size: f kQO gallons
3) Tank constructi or home-made
Tank material: metal wood rctcrete)fiberglass other
4) How many compartment? Single or.stoubte-)
5) Inlet Baffle condition: sa I .y •!• needs repair
Outlet Baffle condition: Alma isf, •. 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? yesdia•/not applicable
7) Tank condition: damaged
Were there repairs made to the tank or the baffles? Yes St -7If yes, please ex lain below.
Drainfield condition: backflow into the tank' //seepage in drainfield(no observed roblems
8) Location where septage was disposed / j
9) Al normal observatio : (If repairs were made,please explain) :)4./.. `j . .
-- _d f-f-1c�C /�
JVS 1 I l" / �l-11°,Az .
Findings and determinations of this inspection reflect con . ions as they existed on the day the septic tank was pumped.
claim is made by this company,ei r express or• plied,conce 'ng uccess or failure of the septic system.
Signature of certified pumper /i—
No Date 5�iZj/4
Albert P. D ouillard
Arrow Septic Service
N.E. 1120 Old Belfair Hwy.
Belfair, Wa. 98528
(360)275-4685 1-800-939-0465