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<br /> SEPTIC SERVICES`
<br /> , :. • • _VA;" • -- . ''
<br /> F
<br /> 503 449 772 '". = �xt•- <
<br /> -
<br /> Septic Tank Inspection%P• umping R• ep
<br /> s . o
<br /> ! se tic tank asp: me a
<br /> Th s,fann is to:be used by•Incensed Septage Haulers who are inspecting and pump ng •P se,bse„.- :lids
<br /> ;• ` Sate:lttspection•or an Operation.and'Maintenance.Permit This inspection rs to be completed •Orillat bs afisertiad by
<br /> r and inspecti•ng:•the tnterror of the septic_tank The ritspectlon;scope is limited tothose
<br /> opening an access to;the se tic lank;.S ectii_caii completing tills form does NOT requir ,exposing the entire top of a
<br /> -. . p...». p Y
<br /> septic tank When inspectin buned masonry products,contractors ate urged to use:caution
<br /> 9
<br /> • City/lownshlp/Vi!lage
<br /> Address .
<br /> F
<br /> hate Tank(sj lnspectedlPumped: [ > .
<br /> TotalNumber of Septic Tanks :.
<br /> Se tic-tank Siies iri gallons Tank#'l. , Tank#2;
<br /> Tank#3
<br /> Tank.,.
<br /> F
<br /> ei plate
<br /> • Tank Lid Types:: `,OPrecast concrete
<br /> QRiseriwith secure Ud at•grade
<br /> OOther:
<br /> Lid Condition Li. intact and in one piece? QYes QNo
<br /> If No, ecify which tank(sj and describe in detail:
<br /> ❑Xes t 1No
<br /> .-.
<br /> •;Ifs} cs hw•sibsle gaps o n the ia•te rieot o+lf'. r "Are ti►ete crah k( )anddescnbe.inBaTank Cardition , - Ye specifywhlc ' ;ttre tan
<br /> e c Io
<br /> • QPre c`ast baf tte
<br /> ofoutlet•devices : Yes ONoT• ype tcr on D ©Vented elbow
<br /> -
<br /> OtletADevice
<br /> a tlds t#adsef puuc m
<br /> e sp mc a heaededa , de tail
<br /> •
<br /> -u Are teou h tnarlscribe
<br /> : ifNo "specify•whia
<br /> :t ' - t ouUPTnk# ,. . .tApP1YQtqu�d le �o oreo finldi aiarea Tank#Checkll Tha ' .OTnk ad runbackfromnefflunt filter Tank#
<br /> ; ,.,cif is maUedwithaambrTank#Notes,or Recommendations
<br /> ::: . . -1': : ''... . ' ' - ..' I.. .....'.;;;13"19-• . .
<br /> '-' _ t inspected and pumped the tanks at the above address and hereby.aitest that:the condtttons as described in this report
<br /> reflect actual site observations. I understand`ttiat the County'may•require.corrective action as the.result of this report;and
<br /> reflect
<br /> corrective action must be a proved by.:Washtena• •
<br /> Cou
<br /> Company Name :2C •fi . ' i.,
<br /> Contractor Signature. D t ..
<br /> •
<br /> Rate: A
<br /> •
<br /> lZev 3 a 1
<br />
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